Savile Investigations (NHS)

Jeremy Hunt Excerpts

Thursday 6th November 2014 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Further to my oral statement on 26 June 2014, Official Report, columns 482-498, I wish to update the House about the investigations into Jimmy Savile and the NHS.

A total of 28 investigation reports into the activities of Jimmy Savile on NHS premises were published on 26 June 2014. We expected the remaining NHS investigation reports, including that relating to Stoke Mandeville, to be published later in the year.

At the request of the Crown Prosecution Service, the publication of the NHS investigations into Jimmy Savile is being delayed until the conclusion of ongoing legal proceedings. Therefore, I wish to advise the House that there will be a delay in the publication of the outstanding NHS investigation reports. We now hope trusts will publish their reports in January 2015, alongside Kate Lampard’s lessons learnt report.

The remaining investigations reports that were not completed in June and are still to be published are:

Five Year Forward View

Jeremy Hunt Excerpts

Thursday 23rd October 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the “Five Year Forward View” for the national health service.

[The Secretary of State for Health (Mr Jeremy Hunt)]

NHS England, along with other NHS organisations, has today published its independent “Five Year Forward View”, which sets out its view of how the health service needs to change over the coming years. It is a report that recognises the real challenges facing the NHS, but it is essentially positive and optimistic. It says that continuing with a comprehensive tax-funded NHS is intrinsically do-able, and that there are

“viable options for sustaining and improving the NHS over the next five years.”

The report says that the challenges of an ageing population can be met by a combination of increased real-terms funding, efficiencies and changing the models of care delivered. It also says that

“decisions on these options will need to be taken in the context of how the UK economy overall is performing.”

In other words, a strong NHS needs a strong economy.

The report proposes detailed new models of care, putting out-of-hospital services front and centre of the solution, delivered through greater integration between primary, community and specialised tertiary sectors alongside national urgent and emergency networks. These can help to reduce demand significantly for hospital services and give older people in particular the personal care that we would all want for our own parents and grandparents.

The report talks about continued opportunities for efficiency savings driven by innovation and new technology, and suggests that they could be increased above the long-term run rate of efficiency savings in the NHS. It talks about reducing variation in the quality of care, in the wake of the tragedy in Mid Staffs, and about how the new Care Quality Commission inspection regime is designed to drive up standards across the system. It says that to do this we will need to move to much greater transparency in outcomes across the health and social care system. Finally, the report makes important points about better integrating the public health agenda into broader NHS activity, with a particular focus on continued reductions in smoking and obesity rates.

The Government warmly welcome the report as a blueprint for the direction of travel needed for the NHS. We will be responding to its contents in detail in due course, but we think it is an important contribution to the debate. We are proud of how the NHS has coped with the pressures of financial constraint and an ageing population in the last four years, but we also know that to sustain the levels of service that people want, the NHS needs to face up to change—not structural change, but a change in the culture of the way we care for people.

Given that the report has been welcomed on both sides of the House, I also hope that this can be the start of a more measured debate about the future of the NHS in which those from all parties in the House recognise our shared commitment to its future and focus on the best way to achieve the strong and successful NHS that the whole country desires.

[Andy Burnham]

A five-year forward view for the NHS, involving more than £550 billion of public spending, briefed to the media but not to Parliament—what clearer illustration could there be of the serious loss of public accountability arising from the Government’s reorganisation? The Secretary of State is in his place today only because he was dragged here by us. I do not know who runs the NHS these days, but I do know that it is certainly not him. We know why he wants to distance himself from this report: because it endorses key planks of Labour’s plan and leaves him with big questions to answer.

First, on GP services, does the Secretary of State agree with the report that primary care has been under-resourced and that people are struggling to get appointments? Will he accept its recommendation to stop his cuts to the GP budget, stabilise funding and match Labour’s plans to recruit 8,000 more GPs?

Secondly, on cancer, the report makes it clear that “faster diagnosis” is needed—we agree. So why did the Prime Minister yesterday dismiss Labour’s proposals for one-week cancer tests?

On integration, the report endorses Labour’s vision for new models of care, including hospitals evolving into integrated care organisations with more salaried GPs. Can the Secretary of State tell the House why he has spent the last few weeks attacking that plan, and is he now prepared to drop his opposition? On public health, is the report not right that the time has come for radical action on obesity, and will he now concede that his voluntary responsibility deal is simply not working?

It will not have escaped people’s notice that the report does not give one mention to competition—that is because it creates fragmentation, when the future demands integration. So will the Secretary of State commit to reviewing his competition rules and vote with Labour in four weeks’ time to repeal them?

Finally, on funding, the report could not be clearer: simply protecting the NHS budget in the next Parliament, as the Conservatives propose, will not prevent it from tipping into a full-blown crisis. As the hon. Member for Totnes (Dr Wollaston), the Chair of the Health Committee, has said, current Tory funding plans raise the spectre of rationing, longer waits and charges. Will he now drop them and match Labour’s plans for more money for the NHS? Labour has set out its plan, and today the NHS endorses that plan. The big question people are asking is: where on earth is his?

[Mr Hunt]

I talked about having a more measured debate, but I think I was speaking a trifle too soon, judging by what we have just heard. The right hon. Gentleman obviously was not listening to what I actually said, so let me just repeat to him that the Government warmly welcome this report. I talked about it as a “blueprint” for the future. He did not agree with setting up NHS England, and I do not think he agreed with the appointment of Simon Stevens as the chief executive, but we did that so that we would have a body that would think strategically about the long-term future of the NHS at arm’s length from the Government. That is what it has done, and the report is excellent.

The right hon. Gentleman and I have a sometimes slightly fractious relationship, but I would like to congratulate him this morning on his Houdini-like spin in the way he is approaching this report. He has been constantly telling this House that the NHS is on the point of collapse, but the chief executive of NHS England says that the NHS has been “remarkably successful” in weathering the pressures of recent years. The right hon. Gentleman has told this House constantly that the biggest threat to the NHS is privatisation and competition. This report, a five-year forward view, by bodies at arm’s length from the Government, contains not one mention of competition and privatisation as a threat, yet he says this report endorses Labour’s plans.

The right hon. Gentleman says, as has his leader, that the first thing he would do in government is repeal the Health and Social Care Act 2012 and strip clinical commissioning groups of their powers. He really should read the report carefully on that. He now says he welcomes the report, but it begs him not to carry out further big structural changes; it does not call for the repeal of the 2012 Act, and this is the report which he warmly welcomes today.

Then we need to consider money. The right hon. Gentleman told this House repeatedly that it was irresponsible to increase spending on the NHS, but now we have a report that says that the NHS needs real-terms increases, along the lines that this Government have been delivering in this Parliament. What does he say? He says, “It is great to have our plans endorsed by NHS England.” This report does not endorse Labour’s narrative; it exposes it for the shallow party politicking that we have had from him.

Let me say to the right hon. Gentleman that the really important message of this report is something we can agree on, and he should be talking about that. We both agree about the integration of health and social care, which is now happening. We both agree about improving investment in primary care. We both agree that we need more GPs. We both agree that we need more care closer to home. I think the public would say that we would have a more measured, intelligent and sensible debate—the kind of debate they want to hear—if we started talking about the things we agree on a bit more instead of constantly pretending there are vast disagreements.

[David Tredinnick (Bosworth) (Con)]

My right hon. Friend has welcomed this report, which says, among other things, that there have to be new ways of working and breaking down barriers. The Royal London Hospital for Integrated Medicine—part of the University College London Hospitals NHS Trust—which is about a mile away from here, is Europe’s largest public sector provider of integrated medicine. Will he go there and see its 13 care pathways, which use qualified complementary and mainstream practitioners, because then it will be clear to him how we can reduce costs in the health service and take the pressure off practitioners? Will he make that part of his package?

[Mr Hunt]

I congratulate my hon. Friend on finding every opportunity to promote integrated care. What the report says is that we need much more person-centred care. It welcomes the kind of models that we see in Tower Hamlets, where the new clinical commissioning groups, led by inspiring leaders such as Sam Everington, are carrying out social prescribing. GPs are actually prescribing social solutions to problems as well as medical ones. This report is a big stepping stone towards that type of integrated care.

[Liz McInnes (Heywood and Middleton) (Lab)]

In my constituency last year, 23,000 people were unable to see their GP within a week. What, if anything, will these plans do to address that crisis?

[Mr Hunt]

I welcome the hon. Lady to her place. This report says something with which this Government very strongly agree, which is that we need to reverse the shift that there has been over many decades of investment away from community care towards hospital care. It is really important that we focus on the role of GPs. We do not want to force all GPs to become employees of hospitals, but we would like to back them, so we have brought back personal responsibility for GPs for every single NHS patient as an important first step in that direction.

[Paul Burstow (Sutton and Cheam) (LD)]

This is an important report, which must not turn into another political football. We should focus on what it says and make that the basis for a real debate about our NHS. There are 23 references in this report to mental health. Parity of esteem is an established idea, but it has not yet been incorporated into NHS practice, so we still have further to go. Does the Secretary of State agree that another area in which we need to go further is perinatal mental health, where the cost to society, to mothers and to generations runs into billions? If the NHS could do a bit more in that regard, it would make a big difference.

[Mr Hunt]

My right hon. Friend is absolutely right. We know that perinatal mental health problems have a big impact on the child as well as on the mother. This report says that we must stop looking at conditions such as mental health as separate to physical health conditions. We need to look at people’s whole condition in the round. If we start to do that, we will make the NHS sustainable by making the kind of investments that will bring down the overall cost of treatments. Putting mental health centre-stage in that approach will be an important part of our strategy.

[Mr Dennis Skinner (Bolsover) (Lab)]

The NHS has been a political football ever since the 1947 Government decided to take it under public control. The Tories fought against it then, and they have fought against it ever since. The important thing to remember is that this report does not commend the Government for carrying out their reconstruction of the health service, which has cost billions. What we did when we were in power for 13 years was increase the amount of money for the health service from £33 billion to £100 billion—a threefold increase in real terms. Had we continued with that approach over the past five years, people would not be dying of cancer because they had not been tested early enough. The Tories talk about all-party agreement, but it is high time that they understood that since 1947 the Secretary of State and his posh people on millionaires’ row have opposed the very essence of the health service, which is why it will be the biggest political issue at the next election. It will also help us to win and get this lousy mob out.

[Mr Hunt]

I think that is the kind of rhetoric that does the whole country a massive disservice. If the Government had the kind of views about the NHS that the hon. Gentleman talks about, we would not have protected its budget during the most difficult recession we have had since the second world war. We actually increased the NHS budget over that period, because we believe in the NHS. With regard to what he says about the report, the chief executive of NHS England, a former Labour special adviser, said this, and it is a fact: “Over the past five years, despite growing pressure, the NHS has been remarkably successful.” That is what Labour people are saying.

[Steve Baker (Wycombe) (Con)]

I very much welcome the plans for urgent and emergency care set out on page 4, in paragraph 10, which ought to produce a solution that could be welcomed in Wycombe hospital and more than 20 similar hospitals across the country. When the proposals are taken forward, will my right hon. Friend ensure that they are explained to people in such a way that they can have real peace of mind that urgent and emergency care will be there for them?

[Mr Hunt]

My hon. Friend, as ever, makes an important point. I do not think that we have been as good as we should have been in the NHS about explaining changes to urgent and emergency care, and people are understandably worried if they think that there is any risk that they will not be able to see a doctor in an emergency, which is what the NHS is there to do. I think that we now have a better blueprint for urgent and emergency care, but the report also recognises that it is not sustainable to say that all urgent and emergency care will always be dealt with in A and E departments. We have to find a way to improve the capacity of primary care and make it easier for people to see their GP so that we can reduce the pressure on hard-pressed A and Es.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Will the Secretary of State take on board the fact —I invite him to visit Calderdale and Huddersfield NHS Foundation Trust to have a look—that the reforms that his Government introduced have fragmented the health service? It is very difficult to find in the health service one common purpose or one common voice. The fact of the matter is that whether it is A and E closures or NICE—National Institute for Health and Care Excellence—prescriptions being handed down by GPs, everywhere I try to find an answer, instead of one voice, one team and one leadership, I find fragmentation and no real positive movement.

[Mr Hunt]

Let me try to reassure the hon. Gentleman. The reality is that those reforms, by getting rid of the huge bureaucracies of the primary care trusts and strategic health authorities—19,000 administrators—have allowed us to hire an extra 10,000 doctors and nurses. We are doing nearly 1 million more operations every year. I will write to him with the details, and I think that he will find that there are more nurses and doctors employed in his constituency now than there were before the reforms.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

May I thank my right hon. Friend for appointing me to be the Government’s pharmacy champion? What role does he perceive pharmacies playing in this, because I think that they are an important part of the whole NHS?

[Mr Hunt]

I had a very enjoyable evening at the pharmacy business awards last night. Pharmacies have an important role to play, because they could save a significant number of A and E and GP visits. The single most important change—my hon. Friend and I have talked about this—is to make it possible, if a patient gives permission, for pharmacists to access their GP record so that they can see their medication history and ensure that they give them exactly the right drugs.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

In the light of this report, is it still the Government’s case that the emerging English hospital trusts’ deficits can be dealt with by efficiency savings alone?

[Mr Hunt]

The Government believe that the NHS has to live within its means, as do individual hospitals. We recognise that that is challenging, and one of the reasons it is challenging is that in the past it has been too easy for hospitals trying to balance their books to cut corners, for example on nursing numbers in elderly care and dementia wards. We have a new inspection regime that has made it much harder to do that, which I think is a good thing, because it means that older people are getting the care they need. It also means a harder road to getting those deficits under control, however.

[Chloe Smith (Norwich North) (Con)]

Page 26 of the document refers to

“an equal response to mental and physical health”.

Despite my right hon. Friend’s good leadership on this topic, I suspect that the document’s authors do not operate an equal funding formula for mental and physical health. Can my right hon. Friend give me any guidance on that?

[Mr Hunt]

We are looking at the issue very closely, and I think that we have made very good progress. We have introduced maximum waiting time targets for some mental health conditions, which has never been done before, and we have made a clear commitment to applying those targets to all mental health treatment during the next Parliament. However, my hon. Friend is right: ultimately, we need to look at funding differently. We need to look at it holistically. We need to understand that it is a false economy not to invest in proper mental health care, because it will only make the overall costs to the system greater in the long run.

[Heidi Alexander (Lewisham East) (Lab)]

The Health Secretary will know that one of the biggest challenges facing the NHS is our ageing population. Thousands of lonely people are living in unsuitable accommodation and are not receiving the care that they need. What proportion of the NHS land that will be sold off over the next five years will be used to create more suitable accommodation for older people, and to create communities of care where they can be given the service and attention that they need?

--- Later in debate ---

[Mr Hunt]

The hon. Lady has made an important point. We would like more NHS land to be sold off for precisely those purposes.

There is a broader point to be made about housing, which is also important, and which I thought the hon. Lady was going to make. If we are to think about care in a more integrated way, we shall need to reform the NHS so that we look at people’s problems holistically, and that will include looking at their housing, which has a direct impact on their health. I think the structures that feature in the five-year plan begin to make such an approach possible for the first time, and I find that very exciting.

[Rehman Chishti (Gillingham and Rainham) (Con)]

Does the Secretary of State agree that the key aim of our reforms is to support hospitals which have not been fully supported before? Medway Maritime hospital, which is in my constituency, had one of the highest mortality rates in 2005-06, but nothing was being done. I thank the Secretary of State for putting the hospital into special measures, so that it can secure the support that it needs to turn things around and my constituents can have an excellent hospital that delivers for them. I also thank him for visiting the hospital recently and meeting its excellent front-line staff, who do a great job.

[Mr Hunt]

I thank my hon. Friend for what he has done for Medway Maritime. That was a very good visit: I met both management and staff, and gained a better idea of the challenges faced by the hospital.

The report makes it clear that we must become much better at tackling variations in care. Never again must we have a system in which hospitals are struggling and delivering poor care, and that poor care is swept under the carpet and nothing is done about it. The Government have put 18 hospitals into special measures—more than 10% of all the hospitals in the NHS—and that has been very challenging. We have been accused by Opposition Front Benchers of running down the NHS when we have done it, but do you know what has happened? Six of those hospitals have now come out of special measures, and nearly all the others have improved dramatically. It is time that the Labour party got behind what is a really good inspection programme, based on openness, honesty and transparency about problems.

[Julie Hilling (Bolton West) (Lab)]

Bolton clinical commissioning group is putting mental health services out to tender, which seems to involve a cut of between a half and a third on the basis of current spending. Are such cuts in mental health services what the Secretary of State means by his vision?

[Mr Hunt]

No, and that is why the Government legislated for parity of esteem between mental and physical health. As I said earlier, we have introduced maximum waiting times for some mental health conditions, and we have focused on improving access to psychological therapies—IAPT—and on dementia. Anxiety and depression and dementia are two of the most common mental health conditions in respect of which we can make a real difference, and we are doing more all the time.

[Margot James (Stourbridge) (Con)]

May I remind the Opposition that the primary care trusts that the clinical commissioning groups replaced sat above primary care, and were remote from it? Let me give an example of how much more integrated the system is now. Our clinical commissioning group has joined our hospital to fund the opening of an urgent care centre, which will relieve pressure on accident and emergency departments and give more patients a chance to gain access to the hospital from primary care. Does my right hon. Friend agree that that is an example of integration, not fragmentation?

[Mr Hunt]

Exactly—that is precisely the point. This report has example after example of how the new structures—clinical commissioning groups—are integrating care. That is why it makes it so clear that it would be wrong to do what Labour wants to do, which is to repeal the Health and Social Care Act 2012 and to strip CCGs of their powers when they are providing precisely the integrated care that we all think is important.

[Nic Dakin (Scunthorpe) (Lab)]

Northern Lincolnshire and Goole Hospitals NHS Trust has made significant progress over the past two years, but it remains financially very challenged and in significant deficit. What, if anything, in these plans will help to remedy that challenging situation?

[Mr Hunt]

Two things. I have had a very interesting visit to Goole hospital. It was very impressive to see how it has responded to the special measures programme and how, as a result of the new inspection regime, which Labour Front Benchers tried to vote down, it has made real improvements in care on the front line for the hon. Gentleman’s constituents. Those at the hospital will be pleased to see that this report endorses the new transparent approach to dealing with variations in care. It also says that we need to continue with increases in real-terms funding for the NHS, which we only get with a strong economy.

[Andrew George (St Ives) (LD)]

The theme of integration is re-emphasised in this plan, but how can commissioners ensure that they achieve that integration if they are forced against their will to outsource many services and also fear that their commissioning decisions will be challenged for being anti-competitive?

[Mr Hunt]

They are not forced against their will to outsource. They make the decisions as to where they want to purchase services from, and they do so on the basis of what is best for patients. Just like the primary care trusts that they succeeded, they have to follow European law in the way that they do that.

[Alex Cunningham (Stockton North) (Lab)]

The growing funding gap over the next five years is a real cause for concern. Can the Secretary of State tell me whether, after five years of changing plans, scrutiny and prevarication, we will finally get approval from his Department and the Treasury for the new North Tees and Hartlepool hospital, or will I have to wait for my right hon. Friend the Member for Leigh (Andy Burnham) to approve it after the election?

[Mr Hunt]

I have met the chief executive involved and heard their case for that, and we are processing it as fast as we can.

[Sir Tony Baldry (Banbury) (Con)]

The Commonwealth Fund’s recent study of 11 national health systems, including those of Sweden, France, Germany and the United States, found that the NHS in England was ranked top for a safe, effective, co-ordinated, efficient, patient-centred care system. Against that background, is it not rather unedifying for Labour Members constantly to try to pretend that the NHS in England is in some form of crisis, particularly given the deplorable performance of the NHS in Wales, which is run by Labour? Would not the shadow Secretary of State do rather better to remember the words,

“Or how wilt thou say to thy brother, Let me pull out the mote out of thine eye; and, behold, a beam is in thine own eye”?

[Mr Hunt]

I welcome the King James Bible reference. The independent Commonwealth Fund report that my right hon. Friend mentions contained one very startling fact, which Labour Members would do well to remember when they go on about the NHS—when they left office, we were seventh out of 11 countries on patient-centred care, whereas this year, now that we are in office, we came top. That is a huge improvement in patient-centred care. Under the new Care Quality Commission regime, his own hospital, John Radcliffe, got a “good” rating, which is an extremely impressive result.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

The ambulance trust in the north-east has quadrupled the use of private ambulances, increasing its costs, and South Tees Hospitals NHS Foundation Trust is in deficit. In my constituency, two urgent care wards and a minor injuries unit are to be closed. A medical centre in Skelton has been closed, a medical centre in Park End has been closed, and a medical centre in Hemlington is to be closed. Does the Secretary of State take any responsibility for any of these health services in my constituency or across England? Every single response we get from him, every single time, is that somebody else is to blame.

[Mr Hunt]

Not at all—I take full responsibility for the NHS. Given the pressures created by having nearly 1 million more over-65s than we had four years ago, and the fact that the Government have had to cope with the deepest recession since the second world war, I believe that the NHS is doing remarkably well, and this document gives it a blueprint for the future that we can all welcome.

[Bob Blackman (Harrow East) (Con)]

Under this Government, the number of young people taking up smoking has fallen dramatically to some 3% and the number of people giving up smoking has increased. I welcome that very good news. We can now aspire to a smoke-free Britain over the next five years. Personally, I would like to see the tobacco companies taxed out of existence, but is it not irresponsible to base future spending plans on the basis of a tax on companies that will cease to exist?

[Mr Hunt]

That is a very good point and I agree with my hon. Friend that we should aspire to a smoke-free Britain. We are making remarkable progress. The point the report makes—this goes alongside what my hon. Friend has said—is that we need to integrate our thinking about public health with our thinking about the services the NHS delivers. The better care fund has shown how it is possible to get excellent collaboration between local authorities and the local NHS for the delivery of social care. Transformational things are happening up and down the country right now. I would like to see the same thing for public health as well.

[Lilian Greenwood (Nottingham South) (Lab)]

Alcohol abuse costs the NHS in Nottinghamshire more than £55 million a year and cuts in social services are making the pressures worse, especially for emergency departments. Dr Stephen Ryder, consultant hepatologist at Nottingham University Hospitals NHS Trust, wrote to me recently to express his deep concern that the Government are not taking forward the introduction of minimum unit pricing. Why are this Government ignoring advice and clinicians and ducking the issue of dealing with cheap alcohol?

[Mr Hunt]

We are doing a number of things to tackle alcoholism. Alcoholism rates have continued to fall under this Government, so we are making good progress. The approach to alcohol is different from that to cigarettes, because responsible drinking is perfectly okay for a person’s health; it may even be good for their health, depending on which doctor they speak to. We want to be careful that our alcohol policies do not penalise responsible drinkers who may not have large salaries and worry very much about the pennies their shopping basket costs.

[Julian Smith (Skipton and Ripon) (Con)]

Women chief executives now lead every one of the three hospitals serving my constituency. We have to thank all members of the NHS for this report, but will the Health Secretary comment in particular on the role of women in delivering NHS change and development?

[Mr Hunt]

I am absolutely delighted to do that. The new hospital inspection regime we have introduced has shone a light on some outstanding leadership. One of the best examples is Basildon hospital, which had terrible problems, including blood-stained floors, blood on the carpets and syringes left lying around in wards. That failing hospital has been turned around by an inspiring chief executive, Clare Panniker, and in the space of just 18 months it has now officially been rated as a “good” hospital by the CQC. We welcome the brilliant leadership of a growing number of female chief executives.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

GP commissioners in Morecambe bay are doing exactly the kinds of things mentioned in the report by shifting their focus from primary care to prevention. They know, however, that all the things they could do will not come close to closing the £25 million deficit. The Government say that they have to close it, but doing so would decimate hospital services. Will the Health Secretary listen to our case about the special funding needs of the area?

[Mr Hunt]

I am very happy to look into that. I recognise that all clinical commissioning groups face very real financial challenges to balance their books. That is why the report is so important, because it says that we cannot go on like this for ever and we have to look at changing the model decisively. It addresses the three things that could give hope to the hon. Gentleman’s CCG: increased real-terms funding based on a strong economy; more imagination in looking for efficiencies; and innovation and technology. We are absolutely committed to doing those things.

[Charlie Elphicke (Dover) (Con)]

In my constituency Deal hospital was left under threat of closure. It has now been safeguarded. Our acute hospitals had a Care Quality Commission inspection to identify problems, which have been dealt with; they were not covered up. Dover hospital, which was wrecked, is now being rebuilt. Will my right hon. Friend take a forward view of his diary and consider reopening that hospital at the opening ceremony in the spring?

[Mr Hunt]

If I possibly can, I will be delighted to do so. This is the pattern in many parts of the NHS that we do not hear from the Opposition Benches—where there have been problems in care year after year, they are finally being addressed. In my hon. Friend’s constituency and the hospitals that serve it he will be seeing more nurses and more doctors being employed and giving a higher standard of care, particularly to vulnerable older people. That is the kind of NHS that we should all welcome wholeheartedly.

[Graham Jones (Hyndburn) (Lab)]

The Secretary of State talks about holistic care and a range of issues that affect people, but active participation in sport, recreation and cardiovascular activity is declining. In constituencies such as mine, that is a real problem. What will he do to integrate CCGs with district councils? He seems to be saying nothing about this.

[Mr Hunt]

In my earlier comments I spoke a bit about childhood obesity, which is a very important issue. I was the Secretary of State responsible for the Olympics, and as part of the Olympic legacy we set up the school games movement, which now has about two thirds of schools in the country doing Olympic-style games every year, and we have put an extra investment into school sport. We need to work closely with the Department for Education on this, and I agree that it is very important that we do so.

[David Morris (Morecambe and Lunesdale) (Con)]

May I invite my right hon. Friend to come to my local hospital and to my constituency to see what good works have been done in my area? A £25 million health centre has opened, we have a new walk-in centre that was opened by the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). May I ask my right hon. Friend’s views on the talk about top-down reorganisation? [Interruption.] We walked into a shambles of an NHS after 13 years of Labour government and a debacle of a CQC policy that we had to reconfigure. What are his thoughts—[Interruption.]

[Mr Speaker]

The hon. Gentleman has had a very full tilt. On the whole, it is a good idea to face the House, rather than the Government Front Bench. We are grateful.

[Mr Hunt]

Of course I would be delighted to visit my hon. Friend’s constituency. Morecambe Bay hospital is one of the hospitals whose problems we are looking at in a way that should have happened before but did not. We are turning round that hospital. We are determined to do it and we want his constituents to have absolute confidence in the quality of hospital care they receive.

[Sheila Gilmore (Edinburgh East) (Lab)]

The Secretary of State told us that a strong NHS needs a strong economy, so I presume he is extremely worried about the fact that reduced tax revenues have led, on this Government’s watch, to higher borrowing this year.

[Mr Hunt]

That is why we continue to take the tough and difficult decisions—[Interruption] that keep this country on the right economic path and which are opposed at every turn by Labour. They told us that our economic plans would lead to a million jobs being lost—[Interruption.]

[Mr Speaker]

Order. The hon. Member for Kingston upon Hull East (Karl Turner) keeps calling out “Ah!” as though he is sitting in the dentist’s chair. It is quite unnecessary. He can exercise his vocal chords later.

[Mr Hunt]

Perhaps the simplest thing is to say to the hon. Member for Edinburgh East (Sheila Gilmore) that we inherited one of the poorest performing economies in Europe. We now have the fastest growing major economy in Europe and that is the best possible future for the NHS.

[Mr Philip Hollobone (Kettering) (Con)]

The report makes it clear that with an increasing population and increasing proportion of elderly patients, the role of GPs will become even more important, yet the demographics of the GP profession mean that we will lose thousands of GPs to retirement in the next few years. What can be done to address this very important problem?

[Mr Hunt]

That is a very important issue and we need more GPs. We have about 1,000 more full-time equivalent GPs during this Parliament but we face the demographic issue that my hon. Friend identifies. That is why we are looking at how we can make it easier for GPs who have stopped practising, perhaps to have a family, to come back into the profession, and how we can make it easier for GPs to do part-time work. We are looking at all those issues because we are committed to reducing the burn-out that many GPs experience by improving and increasing the number of GPs actively practising.

[Mike Kane (Wythenshawe and Sale East) (Lab)]

General practitioner managers throughout the land will be tearing their hair out at the complacency of the right hon. Gentleman’s statement today. According to the patient survey, 39% of people could not see their preferred GP. That is an increase of 1.2 million. My general practice managers in Sale are saying that the situation is at crisis point. Why does the Secretary of State’s view differ from theirs?

[Mr Hunt]

As I have just told the House, I welcome a report that says we need to invest more in general practice. There has been historical under-investment over decades, which is why more and more resources have been sucked into the hospital sector. We are calling time on that and saying that we have to invest more in primary care, community care and out-of-hospital care. It is a big change for the NHS, and I think that the hon. Gentleman’s practice managers will be thrilled to hear it.

[Andrew Stephenson (Pendle) (Con)]

The Secretary of State may be aware that the excellent Airedale hospital, which he has visited, in the neighbouring constituency to mine, has been highlighted in “BBC News” coverage today, especially for its telemedicine service, as an example of what the future of evolving heath care may look like. Will he join me in congratulating the excellent staff at Airedale hospital on embracing change and pioneering new models of care?

[Mr Hunt]

I am delighted to do so. Airedale is mentioned in the “Five Year Forward View” as an example of how technology can be transformative. It has a system under which older people in the locality are given a red button, and as long as their TV is turned on, all they have to do is press the red button and they are talking to a nurse. That is immensely reassuring for them, and it means that they are more likely to stay healthy and happy and to live at home for longer. That is better for them and for the NHS, and it is a real model.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 21st October 2014 Commons Chamber

[Karl Turner (Kingston upon Hull East) (Lab)]

8. How many patients waited longer than four hours in A and E departments in 2013-14.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Of the 21.7 million attendances at all A and E departments in England in 2013-14, 939,000 were not seen and treated within four hours, meaning that 95.7%—0.7% above the national target—were. I am pleased to inform the House that hospitals will have an extra 260 A and E doctors this winter, bringing emergency medics in the NHS to a record high.

[Mr Thomas]

The reason for the big rise in A and E admissions in my area is the weekday closure of the hugely popular Alexandra Avenue polyclinic. Will the Secretary of State look again at Harrow’s NHS funding formula to determine whether that popular service could be reopened?

[Mr Hunt]

I am happy to look at the point that the hon. Gentleman raises. I have visited the Northwick Park A and E department, where the clinicians on the front line are working incredibly hard. As he knows, the funding formula is decided independently—at arm’s length from politicians—but we have ensured that everyone gets a real-terms rise.

[Karl Turner]

Data published last Friday show that A and Es have missed their waiting targets for 64 weeks on the bounce. They are in a worse state now than they were last winter. What is going on?

[Mr Hunt]

First, I caution the hon. Gentleman on his use of statistics, because he is referring to a subset of A and Es, not all of them. Last year we hit our A and E target. I say gently to Labour Members that they need to be careful if they try to politicise operational issues, because people will note that in every year of this Parliament we have hit our A and E targets in England and Labour has missed its targets in Wales.

[Andrew Bridgen (North West Leicestershire) (Con)]

Does the Secretary of State agree that the figures show that the average wait before assessment in A and Es in England is now down to 30 minutes, as opposed to 77 minutes under the previous Labour Government?

[Mr Hunt]

My hon. Friend makes an important point. I just say to the Labour party that the time people wait to be seen at A and Es has reduced while the number of people going to A and Es has increased, but in the end it will not be sustainable unless we invest in out-of-hospital care, which is why we need more personal care by GPs. That is why we have brought back named GPs and why we have 1,000 more GPs than we did four years ago.

[Charlie Elphicke (Dover) (Con)]

May I welcome the outstanding treatment provided at the A and E at the William Harvey hospital—part of East Kent Hospitals University NHS Foundation Trust—which I attended on a family emergency during the summer, and note that the Care Quality Commission is getting striking improvements in East Kent, rather than the sort of cover-ups we used to see in the past?

[Mr Hunt]

My hon. Friend is absolutely right. Under this Government, with the new inspection regime, we have had to take the difficult decision to put 18 hospitals into special measures, including East Kent. Six have now come out of special measures. We are tackling these problems in the NHS by being honest about them. I gently say to the Labour party that if it wants to be the party of the NHS, it has to give the country confidence that it will be honest about poor care when it comes across it.

[Andrew Gwynne (Denton and Reddish) (Lab)]

On A and E, does the Secretary of State accept that we must do more to address the appalling statistic that one in four cancers is diagnosed in A and E departments? At the weekend, Labour outlined plans dramatically to reduce the wait for tests and results, paid for through a tobacco levy, which are supported by Macmillan, Cancer Research UK and the Royal College of Radiologists. Will he now back those plans?

[Mr Hunt]

I welcome the fact that Labour is thinking about how to improve our performance on cancer, because in 2010 we had the worst cancer survival rates in western Europe. I gently say to the Labour party that the issue is only partly about the amount of time it takes to get a hospital appointment when one has a referral; a much bigger issue is the fact that we are not spotting cancers early enough in the first place. That is why I hope that Labour will also welcome the fact that in this Parliament we are on track to treat nearly 1 million more people for cancer than we did in the previous Parliament. That is real progress of which the whole House can be proud.

[Mr Philip Hollobone (Kettering) (Con)]

While it is working with one of the most outdated A and Es in the NHS, and one that will require fresh capital investment, does the Secretary of State recognise the tremendous improvement at Kettering general hospital’s A and E, which in the past year has gone from one of the worst performing to one of the best performing in the country?

[Mr Hunt]

I absolutely recognise that, and I congratulate my hon. Friend on the very close interest he takes in what is happening at Kettering hospital. I have visited the hospital, as he knows, and think that it is working very hard and that it offers a very good example of how, even when times are tough, finances are tough and there is increasing pressure from an ageing population, it is possible to increase and improve A and E performance. It has done a terrific job.

[Ian Austin (Dudley North) (Lab)]

4. What estimate he has made of the number of NHS trusts forecasting a deficit.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Eighty-six NHS trusts are forecasting a deficit this year.

[Ian Austin]

Jobs at Russells Hall hospital are at risk as managers battle with a £12 million deficit that the chief executive says is critical. Staff are working flat out, but people are still waiting too long in A and E, and too long for other treatment. What will the Secretary of State do to ensure that patients in Dudley and the hard-working staff at Russells Hall get the support they need?

[Mr Hunt]

I will tell the hon. Gentleman exactly what we are doing. The Dudley Group NHS Foundation Trust has 350 additional nurses this Parliament, and it has got them because this Government took the difficult decision to protect and increase the NHS budget, because those of us on the Government Benches know that a strong NHS needs a strong economy. We are taking measures, but there is more to do. I recognise that the staff on the front line are working very hard, but I think that he should also give credit when things are starting to move in the right direction.

[Stephen Mosley (City of Chester) (Con)]

My right hon. Friend will be aware of the strains placed on the budgets of the Countess of Chester NHS Trust because of the need to treat thousands of patients every year who are fleeing the disastrous management of Labour in Wales. What action is my right hon. Friend taking to ensure that hospitals on the English side of the border get a fair share of resources?

[Mr Hunt]

My hon. Friend is right to talk about that intolerable pressure on hospitals on the England-Wales border. For every one English patient admitted for treatment in a Welsh hospital, five Welsh patients are admitted for treatment in an English hospital, which creates huge pressure for them. I have written to the Welsh Health Minister to say that the NHS is happy to treat more Welsh patients, but the trouble is that NHS Wales is not prepared to pay for it. That is why Welsh patients get a second-class health service. [Interruption.]

[Mr Speaker]

Order. The hon. Member for Caerphilly (Wayne David) is normally a very calm and reserved fellow—almost statesmanlike. This curious behaviour is quite out of character. He should take some sort of sedative. The hon. Member for Cardiff South and Penarth (Stephen Doughty) can probably advise him.

[Liz Kendall (Leicester West) (Lab)]

With hospitals set to be £1 billion in the red this year, the Secretary of State should be getting a grip of NHS finances. Instead, he is starting on yet another reorganisation. First, he put NHS England in charge of commissioning primary and specialist care. Now, NHS England wants to hand this back to clinical commissioning groups. Ministers have already wasted three years and £3 billion of taxpayers’ money. How much will this Secretary of State’s second reorganisation cost?

[Mr Hunt]

It is lovely spin from the party that carried out nine reorganisations in 13 years. The difficult truth for the Labour party is that this reorganisation that they fought so hard against has been a success. We are saving this Parliament £5 billion. We have reduced the number of administrators by 19,000. We have hired 10,000 more doctors and nurses with the money, and the result is that our NHS, in very difficult circumstances, is doing nearly a million more operations every single year. That is something that we on both sides of the House should welcome and be proud of.

--- Later in debate ---

[David T. C. Davies (Monmouth) (Con)]

14. How many patients resident in England have written to him to request that they be treated in Wales.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Given the perilous state of the NHS in Labour-run Wales, my hon. Friend will not be surprised to know that not a single English patient has written to me asking for funding to be treated in Wales.

[David T. C. Davies]

My hon. Friend is correct. That will come as no surprise to anyone who has had dealings with the NHS in Wales. In the light of that, will he assure us that he will do everything possible to push ahead with the OECD comparison report into the health systems in Wales and England, on which the Welsh Assembly Government are disgracefully trying to obfuscate and cause delay because they are afraid of what might be discovered?

[Mr Hunt]

I am afraid that that says it all. Opposition Front Benchers tell us continually that they are not prepared to condemn what is happening in Wales and that the health service in Wales is performing well, yet here is an opportunity to prove it—an independent study by the OECD of the four NHS systems in the UK—and Labour is trying to block it. This issue matters, because the policies in Wales are what Labour wants to do in England.

[Hywel Williams (Arfon) (PC)]

Will the Secretary of State concede that for many decades people from north Wales have had to travel to England for treatment? In that respect, both Government and Opposition Front Benchers are culpable.

[Mr Hunt]

The Government are happy for people to travel anywhere in the United Kingdom. My concern about health services in England is the pressure created, because for every patient that goes from England to Wales, five want to come from Wales to England.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

17. My right hon. Friend will be aware that his new website, My NHS, is providing much more openness and transparency for patients from England. To what extent does the extra information and ability to improve standards in hospitals as a result also apply to Wales?

[Mr Hunt]

This is the big lesson that we have learned after the tragedy of Mid Staffs. The Francis report said that the NHS had become over-dependent on a targets culture that was damaging for patients, and the Government think that the way to improve standards is through transparency, openness, and the pressure of peer review. We have embraced that lesson wholeheartedly, and it is such a shame that the Welsh Labour Government have taken a different tack.

[Wayne David (Caerphilly) (Lab)]

Has the Secretary of State seen today’s Western Mail? If he has, he will know that the Western Mail, which is not a Labour supporting paper, totally condemns the scaremongering of the Conservative party.

[Mr Hunt]

When I started speaking out about poor care in England—one of the first things I did in this job—those on the Labour Front Bench said that I was running down the NHS. The result of my speaking out is that we are turning around failing hospitals and have 5,000 more nurses on our wards. The NHS in England is getting safer and better, and we want exactly the same thing for Wales.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

15. How many training posts for nurses were commissioned in England in each of the last three years.

--- Later in debate ---

[Heidi Alexander (Lewisham East) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Last week, the Care Quality Commission published its “State of Care” report. This affirmed that the pace and scale of change to improve care in the NHS last year has been unprecedented, but it also contained some hard truths. It found that the variation in the quality of health in adult social care was too wide, and that too many hospitals have not got to grips with the basics of safety. This Government want every NHS patient to have confidence that their care will be both safe and compassionate. We have turned around six hospitals put into special measures, and people saying that their care is safe and compassionate are at record highs. We are determined to change the culture of the NHS away from secrecy towards transparency, and away from targets towards personal care where patients’ needs always come first.

[Heidi Alexander]

In August 2014, 10,616 patients had to wait longer than six weeks for a key cancer test. That is five times the number of people who had to wait that long in May 2010. If the Government do not support Labour’s commitment to a one-week cancer test guarantee, what action will they be taking to reduce waiting times?

[Mr Hunt]

As I said earlier, we welcome the fact that Labour is now interested in cancer policy. If we look at the reason for those delays, which we are working hard to address, it is because the number of cancer referrals—[Interruption.] Labour left this country with the worst cancer survival rate in western Europe; we are doing something about it. The reason for the delays is that the number of people being referred for cancer tests has gone up by 50% since 2010. We are treating record numbers of people with cancer because we want to do something about that survival rate.

[Philip Davies (Shipley) (Con)]

T2. The Public Health Minister is pursuing a long list of nanny state proposals that we might have better expected from the Labour party, including plain packaging of tobacco, outlawing parents smoking in cars and having higher taxes on alcohol. Will she give us a list of which policies, if any, she is pursuing that have a Conservative flavour to them?

[Andy Burnham (Leigh) (Lab)]

At their conference, the Tory party promised flat funding for the NHS in the next Parliament, but experts say that the service is at breaking point now and that the funding promised is not enough. Now, the Secretary of State’s own side are saying the same thing. The Chair of the Health Committee said last night:

“The Chancellor is going to have to write a bigger cheque”

or we will

“see reductions in services or waiting times increase”

and

“go down the route of top-ups and charges”.

Does the Secretary of State agree with her, and will he concede that a flat budget for the NHS in the next Parliament will not stop it tipping into a full-blown crisis?

[Mr Jeremy Hunt]

I am afraid that the shadow Health Secretary is misrepresenting what was said at the Conservative party conference. We promised not just to protect the NHS budget but to protect and continue to increase the NHS budget in real terms. I gently say to him that we have increased the NHS budget spend this Parliament by double the amount that Labour promised at its conference. We did that because on this side of the House we understand a simple truth: a strong NHS needs a strong economy.

[Andy Burnham]

The House will have noticed that the Secretary of State did not answer my question. There is a very simple reason why the Secretary of State cannot answer my question: his party has prioritised unfunded tax cuts for higher earners, leaving a large black hole in the public finances. There will be nothing left for the NHS if the Tories are re-elected. We on the Labour Benches, in contrast, have promised £2.5 billion over and above what they are committed to. Does that not make the choice on the NHS now clear: under Labour, more money for the NHS; under the Tories, tax cuts for some but an NHS crisis for all?

[Mr Hunt]

The right hon. Gentleman cannot have it both ways. The tax cuts the Government have prioritised are for lower-paid people, many of whom work in the NHS. When we had a strike last week, he was criticising the Government for not being more generous, but we have been generous—with the tax cuts he is now criticising. The NHS is facing the biggest financial squeeze in its history partly because of an ageing population but partly because the last Labour Government forgot about the deficit.

[Caroline Dinenage (Gosport) (Con)]

T3. In my constituency, waiting times for GP appointments remain long and practices are struggling to recruit enough doctors. Will my right hon. Friend reassure me as to when the improvements he is making elsewhere in the country will take effect in Gosport, and will he meet me to discuss the matter?

[Mr Hunt]

I would be delighted to discuss it with my hon. Friend, who is right to focus on the role of GPs. If we are to transform the NHS by the end of the next Parliament, we need fundamentally to improve out-of-hospital care, and GPs are at the heart of that. We have recruited 1,000 more GPs during this Parliament, but we need many more, and that will definitely include her constituency.

[Derek Twigg (Halton) (Lab)]

We have a shortage of GPs in Halton. Constituents tell me it is more difficult to get an appointment, and in recent months, two GPs have told me that there are major problems with GP services in Halton and the country as a whole. Despite what the Secretary of State says about increased numbers of GPs, that is not happening in Halton. What is he doing to address the problem, particularly in areas of great deprivation, such as Halton?

[Mr Hunt]

There is pressure throughout the NHS because there are nearly 1 million more over-65s than there were four years ago, which puts pressure on GPs, as it does on any department or hospital providing elective care. However, this is not just about getting an appointment; it is also about ensuring that GPs have personal responsibility for the patients on their list and are accountable for the care of some of the most vulnerable people. We have brought back named GPs with personal responsibility for over-75s, and I hope the hon. Gentleman welcomes our going further and bringing it back for everyone.

[Neil Carmichael (Stroud) (Con)]

T4. Meningitis Now, based in my constituency, is a keen supporter of the Men B vaccination for infants. Given the Joint Committee on Vaccination and Immunisation’s recommendation that it start, will the Minister update us on how the roll-out is progressing?

[Valerie Vaz (Walsall South) (Lab)]

Will the Secretary of State explain why NHS England has entered into a contract with a company based in Kent to provide GP services, when my constituents have just seen a string of locum GPs at a higher cost to the NHS?

[Mr Jeremy Hunt]

Wherever we can avoid it, we do not want to use locum GPs or nurses or agency doctors, because they are much more expensive—our spend on that is far too high—but sometimes when there are issues of patient safety we need a quick solution. That is what has happened in response to the Francis report: as well as recruiting 5,000 additional nurses on a permanent basis, we are using extra agency nurses. However, we hope to bring those numbers down.

[Simon Wright (Norwich South) (LD)]

T5. I congratulate the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb), who has responsibility for care and support, on securing the introduction of NHS waiting times for mental health for the first time next year. How will he ensure that the resulting treatment is not only timely but evidence-based and effective?

--- Later in debate ---

[Charlie Elphicke (Dover) (Con)]

T6. Can the Secretary of State confirm to the House whether there are any plans to sell off the NHS and will the NHS remain free at the point of delivery?

[Mr Jeremy Hunt]

I can confirm that there are no such plans and it will remain free at the point of delivery. Nor do we have any plans to pay private providers 11% more than NHS providers, as happened under the previous Labour Government.

[Sheila Gilmore (Edinburgh East) (Lab)]

In response to my amendment to the Care Bill earlier this year about the portability of care packages to the countries of the UK, the Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb), promised that a voluntary framework would be in place by November. It is 10 days until November, so how is progress going?

--- Later in debate ---

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Will the Secretary of State join me in paying tribute to Eilish Hoole, who sadly passed away in July from ovarian cancer. She was only 47 and the mother of five children. Following her diagnosis of late-stage ovarian cancer she campaigned tirelessly in Parliament with Target Ovarian Cancer, which led to the recent successful pilot of the awareness campaign in the north-west. Will the Secretary of State commit to roll that out to the rest of the country so that other women in her position get to see their children grow up?

[Mr Jeremy Hunt]

I am very happy to pay tribute to Eilish Hoole, to the many cancer campaigners and to the many people who have survived cancer and put their lives back together again. There is still a huge job to do in getting earlier diagnosis. I think there is agreement across the House about the need for much earlier cancer diagnosis, particularly for ovarian cancer, which makes a huge difference. I know that we would all like to pay tribute to her work.

[Tim Farron (Westmorland and Lonsdale) (LD)]

NHS England has identified south Cumbria as one of just three places in England where travel times to receive radiotherapy are unacceptably and debilitatingly long. Will the Secretary of State meet me and NHS England to talk about how Kendal hospital can be the place for a new radiotherapy centre this autumn?

--- Later in debate ---

[Fiona Mactaggart (Slough) (Lab)]

I assume that the Secretary of State has read the National Audit Office’s report on local funding for health care. In the 17 years for which I have been Member of Parliament for Slough, we have never reached our target for funding and now the gap between Slough’s target and our actual funding is greater than ever before. What is he going to do to ensure that areas get the funding they need to provide the health care their residents require?

[Mr Jeremy Hunt]

First, we have made the decision an independent one, taken at arm’s length from Ministers, to try to take the party politics out of it. Secondly, we protected the NHS budget. Thirdly, one of the most important and significant things for the hon. Lady’s constituents has been the way in which the Heatherwood and Wexham Park NHS Trust has been turned round from failing and being in special measures to being taken over and run by Frimley Park NHS Trust—the most successful trust in the country.

[Several hon. Members]

rose—

--- Later in debate ---

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Secretary of State makes great play of protecting the NHS budget, but NHS England, the Nuffield Trust and his hon. Friend the Chair of the Health Committee all agree that it needs another £30 billion investment, so how can he tell people that the NHS is safe under his watch?

[Mr Jeremy Hunt]

We have not just protected the NHS budget, but increased it in real terms, which I think is a huge achievement given the state of the economy we inherited. [Interruption.] I simply say to the hon. Lady that the way to protect and secure NHS funding for the future is by making sure that there is a strong economy to pay for it. That is the single most important thing of all.

[Sir Nick Harvey (North Devon) (LD)]

rose—

NHS Services (Access)

Jeremy Hunt Excerpts

Wednesday 15th October 2014 Commons Chamber

[Andy Burnham]

My hon. Friend puts it very well. If mental health is the poor relation of the NHS, then child and adolescent mental health services are the poor relation of the poor relation. How can that be the case when we are talking about children who need the best possible support—the most vulnerable children—being denied the services that they need? My hon. Friend the Member for Leicester West (Liz Kendall) discussed at a shadow health team meeting a constituency case where a family were trying to find a bed for a child who was in a crisis and not one bed was available for that child in the whole country—not one bed. She is nodding. That is the reality. I wish that Government Members would focus on that rather than making complacent statements.

No amount of spin from the Government can disguise the fact that the NHS is heading for the rocks and urgently needs turning around, so the question is how we get it back on track. I have two positive proposals to put before the House on policy direction and on funding. Let me take each in turn. Instead of just admitting privately that the reorganisation was a mistake, the Government should be actively working with us to begin to put it right—and they will soon have a chance to do so. In five weeks, my hon. Friend the Member for Eltham (Clive Efford) will bring a Bill before this House to repeal the worst aspects of the Health and Social Care Act 2012. When the Government’s reorganisation was going through, their mantra was “Doctors will decide.” The Prime Minister repeated this in his “Today” programme interview during the Conservative party conference when he said:

“there’s nothing we’ve done which makes it more likely there’ll be private provision in the NHS”.

[The Secretary of State for Health (Mr Jeremy Hunt)]

That is true.

[Andy Burnham]

The Secretary of State says that it is true, but that is not how people see it in the real world. Doctor after doctor tells me that their legal advice under section 75 of the Act mandates them to run open tenders for services. Today we see the evidence of how the NHS is changing under that regime. The BBC reports that more than half of contracts awarded by clinical commissioning groups are going outside the NHS. Why is this a problem? Because it is wasting NHS resources on tenders and leading to fragmentation of care when the future demands integration. We need Government Members to tell us today whether they will vote with us on 21 November to repeal mandatory tendering and thus be true to what they originally said they wanted to do, which was to let doctors decide how services are provided.

--- Later in debate ---

[The Secretary of State for Health (Mr Jeremy Hunt)]

I do not think I have ever heard such a misuse of statistics and facts in this House as we have heard today.

I am delighted to debate the NHS, which has been independently rated—[Interruption.] Labour Members do not like to hear this. The NHS has been independently rated by the Commonwealth Fund this year as having become, under this Government, the best out of 11 industrialised countries. It is a better health care system than those in France, Germany and Australia. [Interruption.] Labour Members do not like to hear this, but the independent experts in Washington have said that the NHS has become the best in the world under this Government. The most uncomfortable thing of all for the Labour party is that the NHS has become better than it ever was under the previous Labour Government, when the right hon. Member for Leigh (Andy Burnham) was Health Secretary.

If the right hon. Gentleman wants to talk about Government mistakes, we will do so, but he will find that, on Mid Staffs, the private finance initiative, botched IT projects, a disastrous GP contract, unsafe hospitals, low cancer survival rates and little action on dementia, it is the Labour party, not this Government, that must be held accountable for mistakes in running the NHS. Indeed, after years of mismanagement it is this Government who are finally putting high-quality patient care back at the heart of what the NHS stands for.

[Steve Rotheram]

rose—

[Mr Hunt]

I will give way in a moment, but I want to make some progress.

I want to go through the arguments of the right hon. Member for Leigh in detail, but let me start with the elephant in the room: the massive financial pressure facing the NHS if it is to meet our expectations in the face of an ageing population. There are now nearly 1 million more people over 65 than when this Government came to office. Our economy then was nearly bankrupt. Despite those extraordinary challenges, this Government have been able to increase spending on our NHS—including on Leigh infirmary in the right hon. Gentleman’s constituency—because of our difficult decisions, which were opposed at every stage by the Labour party. Government Members know one simple truth: a strong NHS needs a strong economy.

On the day that unemployment fell below 2 million and the claimant count fell below 1 million, there was nothing in the right hon. Gentleman’s speech about the need for a strong economy to support our NHS and nothing about learning from the Labour Government’s disastrous mistakes, which were so bad that they were in fact planning to cut the NHS budget had they won the election. We should remember that countries that forgot about the deficit ended up cutting their health budgets—Greece by 14% and Portugal by 17%. [Interruption.] Well, these are the facts. We must never again in this country allow the poor economic decisions that have been the hallmark of every Labour Government in history.

[Barbara Keeley]

It is interesting that the Secretary of State is claiming credit for things where the data are based on Labour’s achievements with the NHS, while anything else is our fault. He talked about older people and the demographics of an ageing population, but what good does he think he is doing to that section of the population with £3.7 billion of cuts to social care? Particularly as we move to integration, how does he think that will help those people? In my local area, 1,000 people will lose their care package this year. How does he think that will help the NHS in Salford?

[Mr Hunt]

I will tell the hon. Lady what we are doing: we are integrating the health and social care systems through the Better Care fund—a £3.9 billion programme—which is something that Labour could have done in 13 years in office but failed to do. That will make a massive difference to the social care system. Let us move on to some of the detailed arguments.

[Steve Rotheram]

Will the Secretary of State give way?

--- Later in debate ---

[Mr Hunt]

I will make some progress first.

[Andy Burnham]

rose—

[Mr Hunt]

I am very happy to give way to the right hon. Gentleman.

[Andy Burnham]

This is the most important part of the debate. The Secretary of State is right about the elephant in the room. This is the thing that people in the NHS will pay most attention to today. He has gone through his record in this Parliament, but the problems in the next Parliament will be large, as I am sure he would agree. He needs to say today whether he thinks the ring fence will be sufficient, or does he think that the NHS will need more money over and above the ring fence if it is to avoid crisis in the next Parliament?

[Mr Hunt]

First, let me just correct for the record what the right hon. Gentleman has said. The Prime Minister’s commitment was not just a continuation of the ring fence; he has committed to continue to increase funding in real terms for the NHS. If the right hon. Gentleman looks at the record of this Government, he will see that we have increased spending on the NHS by more, in real terms, than Labour’s promises at its conference. The point about promises is whether the people making them are credible. Which party will deliver the strong economy that can fund the NHS?

[David T. C. Davies]

Will my right hon. Friend confirm that this Government have increased spending on the NHS in real terms by 3%? In Wales, where Labour is in control, there has been an 8% cut in real terms. How can we possibly trust a word Labour says on funding for the NHS?

[Mr Hunt]

That is the point. We get all sorts of rhetoric from Labour, but when we look at its record of running the NHS—whether its disastrous record in England previously, or its disastrous record in Wales today—we see the real face of Labour policies on the NHS, and no one should ever be allowed to forget it.

There has been a lot of discussion about reorganisation. The right hon. Gentleman criticised reorganisation as if it were the last thing in the world that a Labour Government would do, but the previous Labour Government had nine reorganisations in just 13 years. Following the conference season, we know that Labour wants to have yet another one by effectively abolishing clinical commissioning groups in all but name and making GPs work for hospitals. There is widespread opposition to that policy across the NHS.

The right hon. Gentleman has repeatedly claimed that the reforms have cost £3 billion, but the audited accounts show that the reforms will save nearly £5 billion in this Parliament and £1.5 billion a year thereafter. These are the words of the National Audit Office—[Interruption.] He should listen to this, because this is about an independent audit that relates to a key part of his case. These are the words of the National Audit Office in its 2013 report:

“The estimated administration cost savings outweigh the costs of the reforms, and are contributing to the efficiency savings that the NHS needs to make.”

Will he publicly correct the record and accept what the National Audit Office has said, which is that the reforms saved money? The man who is never short of a word is suddenly silent. I have the National Audit Office report here, so he can see for himself. The reforms saved money.

If the right hon. Gentleman wants to talk about wasting money, I am happy to do so. The management pay bill doubled under Labour, compared with a 16% drop under this Government. The private finance initiative schemes left the NHS with £79 billion of debt. The IT fiasco wasted £12 billion. We will take no lectures on wasting money from the party that was so good at wasting it that it nearly bankrupted the country, let alone the NHS.

[Barbara Keeley]

Will the Secretary of State give way?

[Mr Hunt]

I will make some progress.

The right hon. Gentleman said that the reforms have made it harder to access NHS services. The opposite is true. Scrapping the primary care trusts and strategic health authorities meant the introduction of clinical leadership, which he wants to abolish, and allowed the NHS to hire 6,100 more doctors and 3,300 more nurses. Those members of staff are helping the NHS to do 850,000 more operations every single year compared with when he was in office. How can he possibly stand before the House and say that access to NHS services is getting worse, when nearly 1 million more people are getting operations every year compared with when he was Health Secretary?

[John Glen (Salisbury) (Con)]

What is more, the evidence from Labour’s last years in office shows that the number of managers was increasing at three times the recruitment rate for nurses. What does that say about Labour’s priorities in office?

[Mr Hunt]

My hon. Friend is absolutely right. That is why the management pay bill doubled under Labour and why we took the difficult decision, which the Opposition bitterly opposed, to get rid of 19,000 administrators and managers so that we could recruit the extra doctors and nurses. I notice that Opposition Front Benchers are very quiet on that point because they cannot answer the simple question of how they would pay for those extra doctors and nurses if the Health and Social Care Act 2012 was reversed. [Interruption.] Ah! They would pay for the extra doctors and nurses by bringing in new taxes that the country is not paying at the moment.

The right hon. Gentleman talked about structural reforms. We ought to discuss the structural reforms that he chose not to talk about, such as making the Care Quality Commission independent, with new chief inspectors for hospitals, adult social care and general practice. He tried to vote down that legislation in this House. So far—[Interruption.] I know that this is uncomfortable for Labour Members, but they should listen, because the new inspection regime has put 18 hospitals into special measures. Five of them have been turned around completely and have exited special measures, and important improvements are being made at the others.

The motion talks about Government mistakes, so will the right hon. Gentleman finally accept the catastrophic mistakes that he made as Health Secretary, such as failing to sort out the problems at those hospitals, even though there were warning signs at every single one of them? Does he accept that because Labour ignored those warning signs, patients were harmed and lives lost? Will he finally apologise to the relatives of patients at Mid Staffs whom he made wait outside in the cold because he refused to meet them and hear their concerns? Will he make that apology now? He has not apologised and it is clear that he does not want to do so today.

The right hon. Gentleman talked about A and E. Just as when he was Health Secretary, there have been weeks when the target has not been met. What he did not tell the House is that, thanks to our reforms, we have 800 more A and E doctors than four years ago and nearly 2,000 more people are being treated within four hours every single day than when he was Health Secretary.

As the motion refers to Government mistakes, perhaps the right hon. Gentleman might like to acknowledge some of his own mistakes on A and E, such as the 2004 GP contract that removed personal responsibility for patients from GPs, making it more likely that people would end up in A and E, or the failure over 13 years to integrate the health and social care systems, meaning that many vulnerable older people continue to end up in A and E unnecessarily—something that we are putting right through the Better Care programme.

When the right hon. Gentleman spoke about NHS performance, he talked repeatedly about missed targets. That is a really important issue and is perhaps the biggest dividing line between his approach to the NHS and mine. Of course targets matter in any large organisation, but not targets at any cost. That is why the Government have been careful to ensure that in the new inspection regime, waiting time targets are assessed not on their own, but alongside the quality and safety of care.

[Andy Burnham]

The Secretary of State makes an important point, and as Health Secretary, I said that over-reliance on targets was not right. I accept that point, but he now needs to answer a question of mine. He has not removed our targets for A and E or for cancer. Does he consider it acceptable that the NHS is missing the national cancer target? If not, what will he say to reassure families that that will get better soon?

[Mr Hunt]

Let us deal with the cancer target. When the right hon. Gentleman left office—[Interruption.] I am dealing with the cancer target. When he left office, we had the worst cancer survival—

[Andy Burnham]

Forget that—I am asking about now.

[Mr Hunt]

The right hon. Gentleman may want to forget that, when he left office, we had the worst cancer survival rate in western Europe, but why did we have that? We had the worst cancer survival rate in western Europe because we were not diagnosing cancers quickly enough. Under this Government—this is the inconvenient truth for the Labour party—we have treated for cancer nearly three quarters of a million more people than in the last Parliament. We have done that because, as the Prime Minister said, we are referring 50% more people. Access to cancer care has dramatically improved under this Government, and we are starting to climb back up the European league tables.

[Andy Burnham]

Will the right hon. Gentleman give way?

[Mr Hunt]

Let me finish my point about targets because it is important. The NHS over which the right hon. Gentleman’s Government presided was, as the former NHS chief executive Sir David Nicholson said, an NHS where

“patients were not the centre of the way the system operated.”

Labour’s NHS was obsessed with targets, and we have still not had an apology for the policy mistakes that led to Mid Staffs. We have got rid of a number of targets; we are happy to keep a few benchmark targets, but we will not be obsessed with targets at any cost.

May I gently suggest that the Labour party re-read the Francis report? These are Sir Robert’s words about the culture during the Mid Staffs period, when the right hon. Gentleman was a Minister. He described an

“insidious negative culture involving a tolerance of poor standards”

resulting from

“a focus on reaching national access targets”.

If the right hon. Gentleman does not want to listen to Sir Robert, will he listen to families who suffered in Mid Staffs, Morecambe Bay, Basildon and countless other hospitals, all of whom are simply incredulous that Labour wants to put him back in charge of the NHS, while he refuses to acknowledge the terrible problems caused by Labour’s NHS target culture?

The right hon. Gentleman also talked about privatisation. That may hit the spot for his trade union supporters, but it does not stand up to scrutiny. He knows that the use of the private sector for secondary care has grown more slowly under this Government than it grew under Labour. He knows that the biggest single privatisation decision in NHS history—the decision to contract out a whole district general hospital to the private sector—was allowed not by me, but by him when he was Heath Secretary. Let us set the record straight, because he tried to give the impression to my hon. Friend the Member for Selby and Ainsty (Nigel Adams) that that decision was not taken—[Interruption.] Let me make my point, and then I will give way. The right hon. Gentleman approved a shortlist for Hinchingbrooke hospital, which had on it two private sector providers and an NHS provider. He did not tell my hon. Friend that the NHS provider then pulled out, and that he accepted the continuation of that process with an all-private shortlist—[Interruption.] That is what happened, and if he wants to deny it, I will give way to him now.

[Andy Burnham]

The question is: when was that contract signed? Will the Secretary of State answer that question?

[Mr Hunt]

Actually, the question is: when did it become an all-private shortlist, and why did the right hon. Gentleman allow that to happen if he is now saying that the privatised running of hospitals is such a bad thing? I think that we have found him out, and he will want to correct the record and the impression that he gave to my hon. Friend the Member for Selby and Ainsty.

[Mr Simon Burns (Chelmsford) (Con)]

Will my right hon. Friend confirm that in March 2010, when the right hon. Member for Leigh (Andy Burnham) was Secretary of State, the number of bidders for Hinchingbrooke hospital—a process that took place under legislation passed by the previous Labour Government—went from five to three? Two of those bidders were private companies; the third bidder was a private company in conjunction with an NHS trust, but at a later stage as the process developed—as my right hon. Friend said—it went down to one bidder. The right hon. Gentleman said in response to my hon. Friend the Member for Selby and Ainsty (Nigel Adams) that there was a preferred bidder and that it was not a private company but the NHS. It was not the NHS; it was an NHS trust in conjunction with a private company.

[Mr Hunt]

I am grateful to my right hon. Friend because he makes it clear that, when the right hon. Member for Leigh was Health Secretary, he accepted an all-private shortlist. He will want to correct the record on that point.

[Andy Burnham]

The right hon. Member for Chelmsford (Mr Burns) has contradicted the Secretary of State. The right hon. Gentleman said that the bidder withdrew at a later stage, but the Secretary of State said that the bidder withdrew earlier. The Secretary of State cannot have it both ways. The right hon. Gentleman flatly contradicts him.

[Mr Hunt]

The right hon. Gentleman is quite wrong. My right hon. Friend said that there was a list of three providers, all with private provision involved. When the right hon. Gentleman was Health Secretary, he accepted that all-private shortlist for the Hinchingbrooke decision. In other words, the biggest privatisation in NHS history happened because of a decision taken by the shadow Health Secretary.

Government Members are not ideological. We believe there are times when we can learn from the independent sector, but, normally, people use the private sector when they are looking for innovation or better value. Only a Labour Government would sign deals with the private sector, paying 11% more than the NHS rate, and ending up paying more than £200 million for operations that never happened. What a shocking waste of money. When the right hon. Gentleman next talks about privatisation, instead of inventing a privatisation agenda that does not exist, will he apologise for a botched one that existed when Labour was in office?

Finally, there is a comparison that Labour never wants to make when talking about NHS performance: what happens over the border in Wales. That is where the policies that the right hon. Gentleman supports are put into practice. Let us see the difference. A record one in every seven Welsh people find themselves sitting on an NHS waiting list, compared with just one in 17 people in England. The urgent cancer waiting time target has not been met once since 2008 in Wales, but it has been missed in England in only two quarters in the whole period. A and E waiting times have been met every year in England, but they have not been met since 2008 in Wales.

[Lilian Greenwood]

Will the Secretary of State give way?

[Mr Hunt]

No, I will finish this point.

The British Medical Association, no friend of the Conservative party, described the NHS in Wales as being in a state of imminent meltdown. The point is that the NHS in England, like the NHS in Wales, faces huge pressure, but politicising operational problems in England, while denying much greater failings in Wales, is the worst kind of opportunism. For Labour Members, good headlines for Labour matter more than poor care on Labour’s watch. They are playing politics with our NHS. That not only scares people in England, but betrays people in Wales.

I shall conclude—

[Lilian Greenwood]

Will the Secretary of State give way?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The right hon. Gentleman is not giving way. He must be allowed to speak.

[Mr Hunt]

The Government are proud of our record on the NHS in England: more operations for more people; three quarters of a million more people getting the cancer treatment they need; record numbers being seen promptly in A and E; record numbers getting treatment for dementia; and the first ever introduction of maximum waiting times for mental health conditions. It is an NHS under pressure, yes, but it is an NHS preparing for the future, with higher-quality care in hospitals, integrated health and social care, and personal care driven by a much bigger role for GPs.

Some of those changes need money, and we have delivered that, but some of them need a change in culture, different ways of working, more transparency and a more patient-centred approach. That can mean challenging the system, which the right hon. Member for Leigh has never been prepared to do, but which this Government will always do if it is right for patients. We want an NHS building for the long term and an NHS with the confidence of a strong economy behind it. Under this Government, the NHS is independently rated as the best in the world. I oppose the motion.

[Several hon. Members]

rose—

--- Later in debate ---

[Kevin Barron]

I will give way to the right hon. Gentleman in a bit, because I may mention him, as he was a Minister at the time. This Government came to office and passed a Bill through Parliament that was going to introduce competition into the national health service and mean a massive reorganisation, and billions of pounds were going to be spent in doing that—billions of pounds that could have been spent elsewhere—and the case for the defence is, “We’ll make a billion pounds a year in this Parliament.” Well, it is not there yet, Ministers.

It was not just the reorganisation of the national health service that was mentioned. The Government also told us at the same time that they had got to make efficiency savings of 4% a year, something that the health service had never done, and something the public sector had never done. Indeed, people said at the time that the private sector had never done it either.

That is the situation we had when that Bill went through Parliament. They were warned about the consequences of that not just by politicians in the House, but by people who gave evidence to the Public Bill Committee. I served on it. The Bill was stalled and came back in again. Evidence after evidence came in saying what has happened was going to happen.

We have had massive reorganisation. I just wonder if the Secretary of State—if he is prepared to listen—will tell us how many of the 4,000 NHS staff who were laid off and paid redundancy were then re-employed by the NHS, some of them on massive six-figure sums. How much did that cost the NHS? How much did that take away from mental health services or other services that our constituents rely on? None of this is in the debate at all, and Ministers all know perfectly well what the situation is.

Week after week, we hear these platitudes from Ministers. The Secretary of State said not too long ago, “When you go into hospital, you’ll get a named consultant,” but what does having a named consultant matter to most people? Are they going to work seven days a week, 24 hours a day so we can phone and say, “Can we come and see you?” No one has mentioned the latest one we have had, which I thought was wonderful—

[Mr Hunt]

rose—

[Kevin Barron]

The Secretary of State can come in in a minute. This latest one is a consequence of a speech made by the Prime Minister: we are going to be able to see GPs seven days a week. Well, the Royal College of GPs does not think so. I say this to the Secretary of State: “We could see a GP, not far from this place, seven days a week until you lot got in.” We could do so in the Victoria NHS walk-in centre, and I used to go in there, as my GP is elsewhere, but it closed years ago.

We put in walk-in centres—sometimes in the face of opposition from GPs, I have to say. A GP objected to them in my constituency, as I raised in the House at the time, so some of them were saying they did not want them. They gave seven days a week access to GPs.

I understand that my time is up, Madam Deputy Speaker, but I want to finish by saying this: whatever happened at Hinchingbrooke or anywhere else, we never ever had to have competition law on the statute book. We have now. Do not tell me or anybody else out there that the Secretary of State has not got plans to privatise properly the national health service, because I am convinced that he has.

--- Later in debate ---

[Liz Kendall]

I will not. [Interruption.] If the hon. Gentleman is going to talk about Wales, 90% of patients get their treatment within that target, compared with 84% here, so let me save him some time and bother.

The Government’s failure to keep people out of hospital and keep waiting lists under control, means the NHS is facing a looming financial crisis, too. Two-thirds of all acute hospitals are already in deficit to the tune of £500 million. They predict they will end the year £1 billion in the red, piling on the pressure for even greater service cuts and worse standards of care in future.

The tragedy is that it did not have to be this way. After 13 years of investment and reform, the previous Labour Government left the NHS with the highest ever patient satisfaction rates and the lowest ever patient treatment waits. But we were not complacent. We understood that the NHS had to face up to even bigger challenges: our ageing population, the increase in long-term conditions and huge medical advances, at a time when there is far less money around. For that reason, we had a plan in every region to reform front-line services, through Lord Ara Darzi’s NHS next stage review, by delivering some services in specialist centres so that patients got expert treatment 24/7 and by shifting other services out of hospitals and into the community. It was a move towards prevention joined up with social care to help people stay living at home. Instead of going ahead with our reforms, however, the Government scrapped them and forced through the biggest backroom reorganisation in the history of the NHS, wasting three years of time, effort and energy, and £3 billion of taxpayers’ money that should have gone on patient care.

The Health Secretary told the House today, and said on the “Today” programme, that the Government had saved £1 billion.

[Mr Jeremy Hunt]

The NAO said it.

[Liz Kendall]

I actually picked up the copy of the report he left behind, and I found his highlight. It reads:

“The estimated administration cost savings outweigh the costs of the reforms”,

but it does not mention the £1 billion figure. In fact, paragraph 4.10, on the reliability of the Department of Health, states “we found…limited assurance” in the figures. It also states that

“strategic health authority staff did not verify the figures submitted to them by primary care trusts”

and that it

“saw no evidence that the”

Government

“challenged these figures.”

Far from being independently verified, as the Health Secretary claims, they have been made up on the back of an envelope. [Interruption.]

Government Members can complain, but we have constantly argued that the NHS reorganisation has been the single biggest mistake made by the Government, and now we find out that members of the Cabinet agree. An ally of the Chancellor told The Times:

“George kicks himself for not having spotted it or stopped it”.

A former No. 10 adviser says that

“no one apart from Lansley had a clue what he was really embarking on—certainly not the prime minister”.

So we have a Chancellor, who is meant to safeguard public money, failing to stop billions of pounds of waste and a Prime Minister who claimed the NHS was his top priority, but was too confused or complacent to bother to understand his own plans. The Conservative party still does not get it. One Downing street adviser is quoted as saying:

“A lot of work had gone into persuading people that David Cameron believed in the NHS, had personal experience and cared about it. Then the Conservatives came in and forgot all about reassurance. Lansley managed to alienate all the professional people in Britain who were trusted on the NHS.”

The Government’s NHS reorganisation was not just terrible politics; it is terrible in practice for patients, taxpayers and NHS staff. I remind hon. Members that the Health and Social Care Act 2012 did not just create 221 CCGs, 152 health and wellbeing boards, NHS England, Public Health England and Health Education England; it also created four regional NHS England teams, 27 local area NHS England teams, 16 specialist commissioning units—well, there were 19, but at least two have already been merged—and 10 specialist commissioning units. That is on top of Monitor and the Care Quality Commission. It is a system so chaotic and confusing that no one knows who is responsible or accountable for leading the changes patients want and taxpayers need.

And now, just when we thought it could not get any worse, another major new reorganisation is under way. NHS England was commissioning primary care and specialist services, but in May it announced it wanted to give primary and specialist commissioning back to CCGs to try and patch up the fragmentation created by the Government's own plans. How much will this second reorganisation cost patients and staff?

Patients, staff and taxpayers cannot afford another seven months, let alone another five years, of this Government. They need a clear plan to restore care standards and restore care services so that they are fit for the future. Opposition Members would use the savings from scrapping the cost of competition in the NHS to guarantee new rights for patients to see their GP at a time that is convenient for them. We would raise £2.5 billion from a mansion tax, clamping down on tax avoidance and a levy on the tobacco companies to fund more GPs, nurses, midwives and homecare workers to transform services, particularly in the community. We will support carers with new duties on the NHS to identify family carers, a single point of contact for information and services and ring-fenced funding for carers’ breaks. Our plan for whole-person care would ensure the full integration of physical and mental health and social care services into one service with one team to meet all of a person’s needs.

At the next election, there will be a real choice on the NHS: a choice between care going backwards and money wasted under the Conservatives or Labour’s plans to fully join up services to get the best results for patients and the best value for money. It will be a choice between the Conservatives who have broken their promises to protect the NHS, throwing the system into chaos and blaming staff, or Labour who will make the real reforms we need so that people get personalised care in the right place at the right time. It will be a choice between the Conservatives’ unfunded plans to cut taxes for the wealthiest or Labour’s fully funded plans to reform the NHS and care services on which we all rely. I commend the motion to the House.

Ebola

Jeremy Hunt Excerpts

Monday 13th October 2014 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With permission, Mr Speaker, I would like to update the House on the Government’s response to the Ebola epidemic in west Africa.

I shall start with the chief medical officer’s assessment of the current situation in the affected countries. As of today, there have been 4,033 confirmed deaths and 8,399 confirmed, probable and suspected cases of Ebola recorded in seven countries, although widespread transmission is confined to Liberia, Sierra Leone and Guinea. The number is doubling every three to four weeks. The United Nations has declared the outbreak an international public health emergency.

The Government’s first priority is the safety of the British people. Playing our part in halting the rise of the disease in west Africa is the single most important way of preventing Ebola from infecting people in the UK, so I would like to start by paying tribute to the courage of all those involved in this effort, including military, public health, development and diplomatic staff. I would particularly like to commend the 659 NHS front-line staff and the 130 Public Health England staff who have volunteered to go out to Sierra Leone to help our efforts on the ground. You are the best of our country and we are deeply proud of your service.

Among the three most affected countries, the UK has taken particular responsibility for Sierra Leone, with the US leading on Liberia and France focusing on Guinea. British military medics and engineers began work in August on a 92-bed Ebola treatment facility in Kerry Town, including 12 beds for international health workers. In total we will support more than 700 beds across the country, more than tripling Sierra Leone’s capability. With the World Health Organisation, we are training more than 120 health workers a week and piloting a new community approach to Ebola care to reduce and, hopefully, stop the transmission rate. We are also building and providing laboratory services and supporting an information campaign in-country.

We are now deploying the Royal Navy’s RFA Argus and its Merlin helicopters along with highly skilled military personnel, bringing our military deployment to 750. They will support the construction of the Kerry Town Ebola treatment centre and other facilities, provide logistics and planning support, and help establish and staff a World Health Organisation-led Ebola training facility to increase training for health workers.

Taken together, the UK contribution stands at £125 million, plus invaluable human expertise: that is the second highest bilateral contribution after the US’s. However, we do need other countries to do more to complement our efforts and those of the US and France. On 2 October, the Foreign Secretary held an international conference on defeating Ebola in Sierra Leone during which more than £100 million and hundreds of additional health care workers were pledged.

I now move on to the risks to the general public in the UK. The chief medical officer, who takes advice from Public Health England and the Scientific Advisory Group for Emergencies, has this morning confirmed that it is likely that we will see a case of Ebola in the UK. This could be a handful of cases over the next three months. She confirms that the public health risk in the UK remains low and that measures currently in place, including exit screening in all three affected countries, offer the correct level of protection. However, while the response to global health emergencies should always be proportionate, she also advises the Government to make preparations for a possible increase in the risk level. I can today announce that the following additional measures will take place.

On screening and monitoring, rapid access to health care services for anyone who may be infected with Ebola is important not only for their own health, but to reduce the risk of transmission to others. Although there are no direct flights from the affected region, there are indirect routes into the UK, so next week Public Health England will start screening and monitoring UK-bound air passengers identified by the Border Force as coming in on the main routes from Liberia, Sierra Leone and Guinea. This will allow potential Ebola virus carriers arriving in the UK to be identified, tracked and given rapid access to expert health advice should they develop symptoms. These measures will start tomorrow at Heathrow terminal 1, which receives about 85% of all such arrivals across the whole airport. By the end of next week, they will be expanded to other terminals at Heathrow and Gatwick, and to the Eurostar, which connects to Paris and Brussels-bound arrivals from west Africa.

Passengers will have their temperature taken and will complete a questionnaire about their current health, their recent travel history and whether they might be at potential risk through contact with Ebola patients. They will also be required to provide contact details. If neither the questionnaire nor the temperature reading raises any concerns, passengers will be told how to make contact with the NHS should they develop Ebola symptoms within the 21-day incubation period, and allowed to continue on their journey. It is important to stress that a person with Ebola is infectious only if they are displaying symptoms. Any passenger who reports recent exposure to people who may have Ebola or symptoms, and any passenger who has a raised temperature will undergo a clinical assessment and, if necessary, be transferred to hospital. Passengers identified as having any level of increased risk of Ebola but without any symptoms, will be given a Public Health England contact number to call should they develop any symptoms consistent with Ebola within the 21-day incubation period. Higher risk individuals will be contacted daily by PHE. Should they develop symptoms, they will have the reassurance of knowing that this system will get them first-class medical care—as the NHS demonstrated with nurse William Pooley—and the best possible chance of survival.

We expect these measures to reach 89% of the travellers we know have come to the UK from the affected region on tickets booked directly through to the UK, but it is important to note that no screening and monitoring procedure can identify 100% of people arriving from Ebola-affected countries, not least because some passengers leaving those countries will not be ticketed directly through to the UK. Today, I can therefore announce that the Government, working with the devolved Administrations, will ensure that highly visible information is displayed at all entry points to the UK, asking passengers, in their own best interests, to identify themselves if they have travelled to the affected region in the past 21 days. This information for travellers will be available by the end of this week.

We are taking other important measures. We tested operational resilience with the comprehensive exercise that took place on Saturday, which modelled cases in London and the north-east of England. Local emergency services across England will hold their own exercises this week and share lessons learned. It is vital that the right decisions on Ebola are made following any first contact with the NHS, so we have put in place a process for all call handlers on NHS 111 to ask people who report respiratory symptoms about their recent travel history so that appropriate help can be given to higher risk patients as quickly as possible. During recent months, the chief medical officer has issued a series of alerts to doctors, nurses and pharmacists setting out what to do when someone presents with relevant symptoms. We will also send out guidance to hospital and GP receptionists.

The international profile of the UK as a favoured destination inevitably increases the risk that someone with Ebola will arrive here so, working closely with the devolved Administrations, a great deal of planning has gone into procedures for dealing with potential Ebola patients in the UK. All ambulances are equipped with personal protective equipment. If a patient is suspected of having Ebola, they will be transported to the nearest hospital and put in an isolation room. A blood sample will be sent to Public Health England’s specialist laboratory for rapid testing. If they test positive for Ebola, they will be transferred to the Royal Free hospital in north London, which is the UK’s specialist centre for treating the most dangerous infectious diseases. We also have plans to surge Ebola bed capacity in Newcastle, Liverpool and Sheffield, making a total of 26 beds available in the UK.

I will always follow medical advice on whether any measures that we adopt are likely to be effective and are a proportionate response to the risk. However, I believe that we are among the best and most prepared countries in the world.

Lastly, we are harnessing the UK’s expertise in life sciences to counter the threat from Ebola. The UK Government, alongside the Wellcome Trust and the Medical Research Council, have co-funded clinical trials of a potential vaccine, which might be pivotal in the prevention effort. We are working actively with international partners to explore how we might appropriately make further vaccine available.

We should remember that the international community has shown that if we act decisively, we can defeat serious new infectious disease threats such as SARS and pandemic flu. The situation will get worse before it gets better, but we should not flinch in our resolve to defeat Ebola both for the safety of the British population and as part of our responsibility to some of the poorest countries on the planet. Our response will continue to develop in the weeks and months to come, guided by advice from the chief medical officer, Public Health England and the Scientific Advisory Group for Emergencies.

I commend the statement to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for the advance copy of his statement and commend him for making it at the first opportunity.

We have all been horrified by the devastating scenes from west Africa and our hearts go out to the communities that are confronting this threat on a daily basis. Public concern about Ebola is rising here and it is important that people have reliable facts and regular updates.

There are parallels between the current situation and the 2009 swine flu pandemic with which I dealt. I was grateful for the helpful approach of the then Opposition, particularly the right hon. Member for South Cambridgeshire (Mr Lansley), and I aim to provide the Secretary of State with the same approach. However, we do have a role in scrutinising the Government’s approach and I will do that today in a constructive spirit.

I echo the Secretary of State’s tribute to the many NHS staff, Public Health England staff and members of the armed forces who have helped on the ground in west Africa. We have a duty to protect them in any way we can. I want to start with the advice that is given to those who are treating people with the disease. People will be worried by the reports of a second case of Ebola in a health worker, this time in Dallas. We have seen protests in Spain by clinical staff who feel that a colleague has been unfairly exposed to infection. In the light of that, will the Secretary of State say whether he has confidence in the official advice that is being given to those who are treating the disease, and whether it needs to be reviewed?

Let me turn to the risk to the public here. The Secretary of State says that it remains low and the chief medical officer predicts a handful of cases. A handful is not a very scientific term. Will he be more precise and give the House the full range of figures that the advisory group has considered, including the worst case scenario? I recall agonising over whether to publish the official predictions for swine flu and about the risk of worrying the public unnecessarily. However, I think that the public interest lies in openness. Will the Secretary of State confirm that he is planning for the worst case scenario, so that there is no sense of complacency?

Let me turn to our preparedness to deal with an outbreak. There has been confusion about screening at point of entry. Last Thursday, the Department of Health said:

“Entry screening in the UK is not recommended by the World Health Organization, and there are no plans to introduce entry screening for Ebola in the UK.”

Screening was also ruled out by the Secretary of State for Defence. However, just 24 hours later, we were told that screening was to be introduced. Will the right hon. Gentleman say what prompted that about-turn? What official advice has he received from the chief medical officer and Public Health England on entry screening? Based on the science, do they think that it is necessary? Do the arrangements he has announced for temperature checks fully comply with that advice?

As there are currently no direct flights from the affected countries, will the Secretary of State say exactly who will be screened? Will it be all arrivals from those countries? How many people a day or week do we expect that to be, and how will they be identified? Have front-line Border Force staff been properly briefed about what is expected of them, and are they being trained in what to look for and in screening procedures? Why is there only partial coverage of ports of entry? What about sea ports and other UK airports? Will he say where the checks will take place on Eurostar, given that it stops at a number of places en route to London?

On the exercise this weekend, as the Secretary of State will know, a patient was transferred from Newcastle where there are beds in negative pressure isolation units to the Royal Free hospital, which has Trexler isolators. Do the Government believe that Ebola is better handled in Trexler beds, and is the Secretary of State satisfied that the two NHS beds—both at the Royal Free—are sufficient? Given that in addition to the two Trexler beds there are already 24 negative pressure isolation beds, which make up the 26 beds he referred to, will he say what he means by “surge Ebola bed capacity”? If it becomes necessary to treat Ebola cases more widely in isolation beds, is he satisfied that there is adequate provision across England? Is he satisfied that all relevant NHS staff, including GPs, ambulance and 111 staff, know how to identify Ebola, the precautions to take in any potential presentation, and the protocols for handling it? He mentioned symptoms a few times in his statement. For the public watching this statement, will he tell the House simply what those symptoms are?

On treatment, the British nurse who was successfully treated here was offered and took an experimental medication called ZMapp. Will it be standard practice to offer all affected patients ZMapp, and if so, are there sufficient supplies in the NHS to do that? The Secretary of State rightly focused on a vaccine, which would of course be the best reassurance we could give the public. During the swine flu pandemic, huge effort went into compressing the timetable for the development of a vaccine. Is he confident that everything that can be done is being done to speed that up?

Finally, as the Secretary of State said, the best way to protect people here is to stop Ebola at source. The UK has rightly pledged £125 million to assist Sierra Leone, but with cases doubling every three to four weeks there is wide agreement that the response of the wider international community has been slow and inadequate. The window to halt Ebola before it runs out of control altogether is closing fast. What assessment has been made of the resilience of neighbouring countries such as Guinea and Liberia, and what help is being offered to them? The International Development Committee report was clear that the lack of proper health coverage allowed the outbreak to grow unchecked for so long. Does the right hon. Gentleman accept that improving global health systems is the best way to prevent these outbreaks, or at least ensure that they are caught before they get out of control? Many countries support placing universal health coverage at the centre of global development, yet the UK is currently opposing such plans at the UN. Will he say a little more about the Government’s position on that, and whether they are prepared to reconsider it in the light of recent events? Knowing from my experience how difficult these situations are, I assure the Secretary of State that the offer of help is genuine, but on behalf of the House I ask him for regular updates and maximum openness in the weeks and months to come.

[Mr Hunt]

I thank the shadow Health Secretary for the constructive tone of his comments. That is totally appropriate and I am grateful. I will start with the point on which he finished, because the most crucial thing we can do to protect the UK population is deal with the disease at source and contain it in west Africa. That is why I am working extremely closely with the International Development Secretary, and she is working closely with me because the role of NHS volunteers is important. The right hon. Gentleman is absolutely right: the initial international response has focused on taking the three worst affected countries and giving them a partner country in the developed world to help them—we are helping Sierra Leone, America is helping Liberia, and France is helping Guinea.

That has worked up to a point, but we need more help from the rest of the international community. I had a conversation earlier today with US Health Secretary Burwell. We talked about a co-ordinated international response for the whole of west Africa, because we will not defeat this disease if we operate in silos. We need to recognise that this disease does not recognise international boundaries; the right hon. Gentleman was absolutely right to make that point.

Let me try to give the right hon. Gentleman some of the information he requested. First, he is absolutely right to raise the issue of the protection of health workers. That has to be our No. 1 priority both here in the UK and abroad. That is why we are building a dedicated 12-bed facility in Sierra Leone that will give the highest standards of care, equivalent to NHS standards of care, for health care workers taking part in the international effort to contain the disease there. That is also very relevant to health care workers here: events in both Spain and the US will have caused great concern.

I am satisfied that the official advice to health care workers is correct. The Centers for Disease Control and Prevention in the US, the US equivalent of Public Health England, believes that breaches in protocol led to the infection of the US nurse—the case we have seen in the media recently—but it is investigating that. The advice is always kept under review and if that advice changes we would, of course, respect that. It is important that we follow the scientific advice we have, but that the scientists themselves keep an open mind on the basis of new evidence as it emerges. I know that they are doing that.

The right hon. Gentleman talked about the full range of figures. He is absolutely right to say that we will maintain public confidence in the handling of this by being totally open about what we know. The reason we have stuck carefully to the formula of “a handful of cases” is because it is genuinely very difficult to predict an accurate exact number. Let me say this: we would not have used the formula of “a handful of cases” if we thought that the number of cases over the next three months would reach double figures. However, it is also important to say that that was a current assessment. That assessment may change on the basis of the evidence. I will, of course, keep the House informed if it does change.

The right hon. Gentleman talked about screening. It is important to deal with a misunderstanding. Why did the policy change on Thursday? The answer is that it changed because the clinical advice from the chief medical officer changed on Thursday. Her advice changed not on the basis that the risk level in the UK had changed—she still considers it to be low—but because she said that we should prepare for the risk level going up. That is why we started to put in place measures, but they are not measures primarily intended to pick up people arriving in the UK who are displaying symptoms of Ebola. We think that most of those people should be prevented from flying in the first place. The measures are designed to identify people who may be at risk within the incubation period of developing the disease, so that we can track them and make sure they get access to the right medical care quickly.

As I mentioned, we think we will reach 89% of people arriving in the UK from the affected countries. We will continue to review that. If the numbers increase and the risk level justifies it, we have contingency plans to expand the screening, for example to Birmingham and Manchester. The reason we have included Eurostar at this early stage is because there are direct flights from those three countries to Paris and Brussels, from where it is easy to connect to Eurostar. We will use the tracking system for people who are ticketed directly through to the UK in order to identify, where we can, people who then independently get a Eurostar ticket. It is important to say that because they are changing the mode of transport in Paris and Brussels, tracking is not as robust as it would be for people taking a direct flight to the UK. We will not be able to identify everyone, which is why we need to win the support of people arriving in the UK from those countries, so that they self-present, in their own interest, to give us the best possible chance of helping them if they start contracting symptoms.

I am satisfied that the Trexler beds and the negative isolation rooms are safe both for health care workers and in preventing onward transmission. They use different systems—one of them is a tented system and the other is based on people wearing personal protective equipment —but I am satisfied that both of them are safe. I will continue to take advice on that. It is very important that ambulance staff know that someone is a potential Ebola case, so that they wear the PP equipment.

As we will not be able to identify everyone who comes from the affected countries, it is important that the 111 service knows to ask people exhibiting the symptoms of Ebola whether they have travelled to those affected areas. The right hon. Gentleman asked what those symptoms are. They are essentially flu-like symptoms, but they are not dissimilar to the symptoms someone might exhibit if they had, for example, malaria. That is why it is important to ask for people’s travel history and whether they have had or may have had contact with people who have had Ebola, in order to identify the risk level.

We would like to continue using ZMapp for people in the UK who contract the disease, but that is subject to international availability. It might not be possible to get it for everyone, because there is such high international demand, but we will certainly try.

In terms of the development of a vaccine, we are doing everything we can to work with GSK to bring forward the date when a vaccine is available. Indeed, we are considering potentially giving indemnities if the full clinical trials have not been conducted.

[Dr Sarah Wollaston (Totnes) (Con)]

May I welcome the Secretary of State’s statement and pay tribute to all the staff who are giving him professional detailed scientific advice? I join him in paying tribute to all the NHS personnel, our forces personnel and diplomatic staff putting their own lives at risk in west Africa.

I am particularly pleased to hear that those individuals returning to the UK or coming to the UK from west Africa will be able to access support in a timely manner and in a manner that does not put other individuals at risk in crowded health care settings. Will the Secretary of State say more about the testing arrangements, which I hear are going to be at Porton Down? Does he have any plans to make further testing centres available so that testing can happen more rapidly?

[Mr Hunt]

I thank my hon. Friend for her comments and her support for the statement. I want to pay particular tribute to the chief medical officer and Dr Paul Cosford at Public Health England, who have done an enormous amount to make sure we develop the right policies, which are both proportionate and enable us to prepare for the future. The Government are hugely grateful for their contribution.

We are satisfied that the testing arrangements at the PHE facility at Porton Down are adequate to the level of risk, but one of the reasons why I wanted to announce to the House the current estimate of the number of Ebola cases we are dealing with in the UK was to make the point that we will continually keep those arrangements under review should the situation change. We need to recognise in a fast-moving situation such as this that it might well change, and I will keep the House updated, but in such situations the resilience of all those very important parts of the process will be checked.

[John McDonnell (Hayes and Harlington) (Lab)]

In May the Government announced the closure of the health control unit at Heathrow airport in my constituency. It contained the staff who undertook the monitoring, screening and treatment of passengers who were sick. I believe many of those staff have now been made redundant, so can the Secretary of State tell me what the staffing arrangements will now be at Heathrow airport? Also, will a training programme be developed for airport staff themselves, including cabin crew and others?

[Mr Hunt]

The hon. Gentleman makes a very important point. In terms of the staffing arrangements, a total of about 200 people will be employed in the screening process, working at both Heathrow and Gatwick airports in the hours when they are open, and potentially at other airports if we expand the screening. It is a comprehensive facility.

The hon. Gentleman’s most important point is that we must make sure that those who might come into contact with people who might have Ebola—airport staff and people working on aeroplanes, and people working at receptions at GPs’ surgeries, at A and E departments and at hospitals—have basic information about how the virus spreads, so that we can avoid any situations of panic. The virus is transmitted through exchange of bodily fluids. It is not an airborne virus, so it is not transmitted as easily as something like swine flu. The advice is that those doing physical examinations of patients need to wear the protective equipment, but that that is not necessary when having a conversation with a patient, for example. That advice will always be kept under review, but the hon. Gentleman is absolutely right to say that we need to make sure everyone knows that advice.

[Sir Malcolm Bruce (Gordon) (LD)]

The work that the British Government have done in Sierra Leone and Liberia to build health systems has been extremely important, but those systems were clearly inadequately developed to cope with this kind of problem. I welcome the joined-up thinking across government, but will the Secretary of State give me an assurance that the legacy of this situation will be not only that we have contained Ebola but that we have built health systems in those countries that are capable of dealing with future outbreaks? The long-term legacy must be stronger health systems, as well as the protection of British citizens, which is of course important.

[Mr Hunt]

I remember working with the right hon. Gentleman on the International Development Select Committee many years ago, when we had many conversations about strengthening the resilience of local health care systems. He is absolutely right to say that that must be our long-term goal, and I will ask the Secretary of State for International Development to write to him to explain how our efforts in Sierra Leone will help to strengthen its local health care system in the long run. The simple point I would make is that this illustrates the dual purpose of our aid budget more powerfully than any example I can remember. First, our aid budget gives humanitarian assistance to some of the poorest countries in the world and, secondly, it protects the population at home in the UK. Those two aims go hand in hand.

[Ian Paisley (North Antrim) (DUP)]

I welcome the Secretary of State’s statement and I appreciate having been given an advance copy of it. He mentioned the devolved regions. First, will he tell us which Minister in Northern Ireland will take personal responsibility for this matter? Secondly, he will know that the main point of entry for potential victims of this terrible disease is the Republic of Ireland. What special measures are being put in place to stop people using those points of entry to travel from the Republic to Northern Ireland when there are no apparent protective measures in place?

[Mr Hunt]

The Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), has been in touch with Jim Wells in the Northern Ireland Assembly and she will take up that issue. The broader point that the hon. Member for North Antrim (Ian Paisley) makes is that there are many points of entry into the UK, and it is important for us to recognise that our screening and monitoring process will not catch absolutely everyone who comes from the affected regions. That is why we need to have other plans in place, such as the 111 service, and to have encouragement at every border entry point for people to self-present so that we can protect them better, should they develop symptoms.

[Mr Andrew Lansley (South Cambridgeshire) (Con)]

I welcome the Secretary of State’s statement to the House, and I am also grateful to the shadow Secretary of State for what he said. All Members share the Secretary of State’s admiration for the staff of the NHS and Public Health England who are assisting in the front-line treatment and care of those in west Africa. In that context, he is right to try to tackle the virus in west Africa, but this is not just about the availability of much better treatment facilities; it is also about working in the community in short order to try to stem the continuing transmission of the disease. Work has clearly been done on that; will he tell us how we might scale it up?

[Mr Hunt]

My right hon. Friend makes an important point. I discussed this with United States Secretary Burwell today. The US is piloting a programme in Liberia, and we are doing the same thing in Sierra Leone. We are both providing the same response, which is to tackle the disease at source. We know that, if we can get 70% of the people who develop Ebola symptoms into treatment and care, we will contain the disease. At the moment, the disease is replicating at a rate of 1.7, which means that every 10 people infected are going on to infect another 17 people. That is why the virus is spreading so fast, and we can halt it only if we get people into treatment very rapidly. Community treatment centres are therefore an important part of the Department for International Development’s strategy to help to contain the virus, and that is why we are supporting the development of 700 beds in Sierra Leone.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

May I beg the Secretary of State to work across Europe and all the countries that can help? I have a daughter who has just returned from west Africa and she has reported to me and the family that the situation is critical—it is desperate. There is a lack of any kind of facility to control this disease. Parents are dying, leaving children with nobody to care for them. The situation is very grave, so will he redouble his efforts to persuade Europe, the World Health Organisation, the UN—all of us—to do something more significant and to do it now?

[Mr Hunt]

The hon. Gentleman speaks movingly and well about the incredible gravity of the situation, and he rightly says that we need full international support on it. In such a situation there are a number of things we are much better tackling as part of an international effort; we are very proud of our 659 NHS volunteers, but volunteers from the whole of Europe could go out and play a part. They need reassurance that they will be safe if they end up contracting the virus, because the truth is that there is no 100% guarantee of safety, even for people who follow the correct procedures—that is why these people are so brave. The hon. Gentleman is absolutely right in what he says, and I reassure him that that is exactly the conversation I have been having with international colleagues: we do need a co-ordinated effort.

[Bob Stewart (Beckenham) (Con)]

The military have superb experience of dealing with contaminated areas. Are contingency plans in place to bring the military services into line to help, should that be required?

[Mr Hunt]

We are doing that already: we have made a commitment of 750 military personnel, who will be going to the affected region to help; we have military engineers helping to build the 92-bed facility in Kerry Town; and Royal Fleet Auxiliary Argus is on the way to Sierra Leone. We are tapping into that expertise, and it has a vital role to play.

[Michael Connarty (Linlithgow and East Falkirk) (Lab)]

Following on from the question put by my colleague from Northern Ireland, the hon. Member for North Antrim (Ian Paisley), clearly the nearest hospital to Scotland with provision is in Newcastle. Who is the responsible person with whom the Secretary of State has been working in Scotland? What arrangements are taking priority in Scottish towns, because someone who has 21 days to travel in the UK might not wish to stay in England alone?

[Mr Hunt]

The hon. Gentleman is right in what he says. This morning, my hon. Friend the Under-Secretary spoke to Alex Neil, the Scottish health Minister, and on Wednesday we will have a Cobra meeting with the devolved Administrations to test how resilient the structures are between the constituent parts of the UK. That is a very important part of our effort.

[Martin Horwood (Cheltenham) (LD)]

Perhaps I should declare a non-pecuniary interest, Mr Speaker, as my wife works for Public Health England. I join the Secretary of State in applauding all of her colleagues and the others who are putting themselves in harm’s way in the front-line battle against Ebola. Given his predecessor’s reorganisation of the NHS and of public health, does the Secretary of State need to check whether there are now sufficient local directors of public health in post and whether they have sufficient resources, qualified staff and seniority within local authorities to take a local lead, should that be necessary, in the fight against Ebola?

[Mr Hunt]

We are absolutely checking that, and it is all in hand.

[Fiona O'Donnell (East Lothian) (Lab)]

I do not know whether the Secretary of State has any plans to speak to the hon. Member for Clacton (Douglas Carswell), but if he does will he ask him why he now supports a party that would decimate the UK’s aid budget? Does the Secretary of State, like me, feel a great sense of pride in being part of a family of nations whose aid budget is saving lives in Liberia and Sierra Leone, and, in turn, keeping people in the UK safe?

[Mr Hunt]

The hon. Lady speaks extremely wisely and there is cross-party agreement on that matter. That shows why it is so wrong to make an artificial division between helping people abroad and helping people at home. I think we have a moral responsibility to help people in the poorest countries abroad in any case, but in my time in this House there has been no better example than this one of how doing so is in the interests of people in the UK, too. It helps to make us more secure, and we can be incredibly proud of the work we are doing as a result.

[Mr Nigel Evans (Ribble Valley) (Con)]

The Secretary of State has spoken about multiple points of entry, and major connection points are via Schiphol, Charles de Gaulle, Madrid and Frankfurt. Has he spoken to his opposite numbers in those countries to see whether they are following the best practice that is being rolled out in the United Kingdom? Will he ensure that those who are manning the points of entry in the UK have the ability to deal with children, because if a parent is detected with symptoms, their children will have to be properly looked after?

--- Later in debate ---

[Mr Hunt]

My hon. Friend makes an important point. I am sure that those arrangements are already in place, but I will ensure that they are. Yes, we are in touch with colleagues in other countries. It is important to say that there are only a very few direct flights to Europe from the affected region, and indeed there are none to the UK. At the moment, it is possible to be fairly confident that we will reach the vast majority of people who come from those affected areas. But part of what I am trying to convey in this afternoon’s statement is that the risk level could change—for example, there could be a breakdown in public order in the affected countries—which is why we need to be prepared for a much more porous situation, with people coming from many different points of entry.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Is the Secretary of State talking to our universities, as a number of them must have overseas students from west Africa returning for their studies in October? Is he focusing on them in particular, and what provisions are we making to cater for them?

[Mr Hunt]

The hon. Lady makes a very important point. Clearly, it is important that anyone who comes from those countries, whether a student or a visitor, is treated with the same screening and monitoring process. Screening and monitoring people simply on the basis of their passport would not work. There will be people who have indefinite leave to remain in the UK but who have a Sierra Leonean passport, and it would not be appropriate to put them through that process. It is most important that we have a system in place in which we can check and find out who has been to the Ebola-affected areas in the past three weeks, so that we can give them help if they need it.

[Jason McCartney (Colne Valley) (Con)]

My right hon. Friend has given details of plans for extra Ebola bed capacity in regional centres such as Sheffield. Will he confirm that those regional centres will be used alongside the Royal Free hospital in London, or will they be used only when capacity there has been reached?

[Mr Hunt]

Essentially, the plan is to start with the Royal Free, which has capacity to go from two beds to four. Then we have six beds available in Newcastle and Liverpool and two beds available in Sheffield. Following that we can further expand capacity at the Royal Free.

[Fiona Mactaggart (Slough) (Lab)]

Will the Secretary of State ensure that British citizens fleeing Ebola-affected countries are not left destitute and homeless? My constituents Mr and Mrs Mahmood have been working in Sierra Leone for the past four years. When they returned, they were told that they were not eligible for income-based jobseeker’s allowance or housing benefit. Will the Secretary of State speak to his counterparts at the Department for Work and Pensions to ensure that no British citizen is left in such a state when they have to flee a country that is affected by Ebola?

[Mr Hunt]

If the hon. Lady lets me know the details of the individuals concerned, I will happily take up the case.

[John Hemming (Birmingham, Yardley) (LD)]

A systemic lacuna in the Government’s proposals relates to the lack of monitoring of lower-risk travellers. Will the Secretary of State consider having daily contacts with such travellers on the basis that identifying erroneous risk assessments at the first stage is the key to bringing things under control in the interests of the travellers as well?

[Mr Hunt]

The judgment on how effective we are at identifying higher-risk passengers must be made by the scientists and the doctors involved. Their view is that we are currently going further than we need to given the current risk level, but that it is prudent to do what we are doing because that risk level might increase. I will always listen to their advice.

[Ms Margaret Ritchie (South Down) (SDLP)]

I thank the Secretary of State for his statement on Ebola. Given that one of the busiest air routes within these islands is that between London and Dublin—the hon. Member for North Antrim (Ian Paisley) has already referred to the role of the Republic of Ireland—will he outline what discussions have taken place between him and his officials and the Minister for Health and his officials in the Republic of Ireland?

[Mr Hunt]

The hon. Lady makes an important point. The Under-Secretary of State for Health, my hon. Friend the Member for Battersea, has been in contact with the Northern Ireland Health Minister, and we will pursue discussions with the Republic of Ireland. Although the hon. Lady’s concern is legitimate and it is right that she has asked the question, it is important to say that the current assessment is that the risk level to the UK is low. I would imagine that the risk level in Ireland is similarly low, but that is ultimately a matter for the Irish authorities. At the moment, we are following a precautionary process just in case the risk level increases. We will of course involve colleagues in the Irish Republic in our assessment of those risks.

[David Rutley (Macclesfield) (Con)]

I am pleased that my right hon. Friend is focusing on the protection of health care workers in the vital work he is taking forward. Given that lessons are still being learned from cases in Texas and Madrid, what mechanisms are in place to update procedures when any new findings are brought into the public domain?

[Mr Hunt]

My hon. Friend is absolutely right that what happened in Dallas is of great concern. We need to listen to our colleagues in the Centre for Disease Control in the US as they try to understand exactly what happened. If they decide that we need to change the protocols for protecting health care workers, we will of course take that advice extremely seriously. At the moment, their scientific assessment is that there was a breach in protocol, not that the protocols were wrong. Until we identify what those breaches were, we cannot be 100% sure. We are working very closely with them and we have a good and close working relationship. We will update our advice to UK health care workers accordingly.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I thank the Secretary of State for the answers he has given so far, but my right hon. Friend the Member for Leigh (Andy Burnham) asked whether he was satisfied that all relevant NHS staff, including all GPs, know how to identify Ebola, know the precautions to take with patients presenting, and know the protocols for handling Ebola. I did not get a sense from the Secretary of State’s reply of how complete that knowledge is. He has talked a lot about receptionists, and that is important as they are in the front line of risk, but hospital cleaning staff and cleaning staff in GP practices are also at risk if such patients present.

[Mr Hunt]

The hon. Lady makes an important point, but I reiterate the point I made earlier to another hon. Member. The risk level to the UK general population remains low, so the measures we are taking are precautionary because of a possible increase in that risk level. As part of that, we are sending advice to everyone we think might be in contact with anyone who says that they have recently travelled to the Ebola-affected areas and who displays those symptoms. That is why alerts have gone out to hospitals, GP surgeries and ambulance services to ensure that they know the signs to look for and are equipped with that important advice.

[Mr Philip Hollobone (Kettering) (Con)]

To cross a typical western international border illegally, one needs a passport and passports are meant to have stamps in them. What steps are we taking with the seven most affected west African countries to ensure that they stamp the passports of people who go into and leave those countries so that we can readily identify the stamps in their passports should they come to the UK? What extra resources is Border Force putting into checking the stamps in people’s passports when they come to the United Kingdom?

[Mr Hunt]

I will get back to my hon. Friend with the exact details of what is happening with passport stamps, but I reassure him that we are working very closely with Border Force officials and we have a high degree of confidence that we will be able to identify the vast majority of people who travel from the most directly affected countries within the recent incubation period of the virus. It is important to remember that that incubation period is 21 days, so we are looking at the previous three weeks. We have a high degree of confidence, but I will get my hon. Friend information on whether passport stamps could be an additional source of security.

[Keith Vaz (Leicester East) (Lab)]

I join others in congratulating the Secretary of State on initiating screening, as he did on Thursday. That is the right approach, as is targeting it at certain ports. As he knows, viruses do not wait for direct flights and it is extremely important that there is a synergy between our screening processes and those of Sierra Leone and other west African countries. Did we supply the screening equipment, and if we did not, is he satisfied that it is fit for purpose? The same goes for the screening in other hubs throughout Europe.

[Mr Hunt]

We have absolutely checked the screening equipment that is being used in those three countries, and in Sierra Leone, which is our more direct responsibility, that is being done by Public Health England officials. The reports that we are getting back say that people are checked not just once, but several times. It is really important to say that the main purpose of the screening that we are introducing—I call it screening and monitoring, rather than screening—is to identify passengers who may be at higher risk. We are not particularly expecting to identify people showing symptoms because they should have been prevented from leaving the country in the first place, but we want to keep tabs on them while they are in the UK, in their own interests, and that is the purpose of the process.

[Mr David Nuttall (Bury North) (Con)]

I thank the Secretary of State for his statement. Given the large number of languages in use in that part of west Africa and the consequent practical difficulties in producing notices and posters that travellers can actually read for the purposes of self-presenting, may I ask my right hon. Friend in what circumstances he would reconsider the decision not to introduce the screening and monitoring of passengers arriving at Manchester airport?

[Mr Hunt]

We have not yet made a decision on Birmingham and Manchester, and we will continue to review the risk advice from the chief medical officer and PHE on whether such action would be appropriate. It is important to say that the measures we take must be proportionate, but they must also look forward to potential changes in the risk, so that we can react very quickly were that risk to increase dramatically, and that is exactly what we are doing at other UK airports.

[Jeremy Corbyn (Islington North) (Lab)]

I thank the Secretary of State for his statement and for the support given to health services in west Africa, but does he not agree that this terrible time shows the massive health inequalities that exist all around the world and that, although there will be a big international effort to deal with Ebola, it calls into question the effectiveness of the millennium goals on preventive health measures, not just in west Africa, but in a much wider sense? Do we not need to redouble our efforts to reduce health inequalities around the world for the protection of everyone?

[Mr Hunt]

The hon. Gentleman is right, although the millennium development goals have been successful in making a start on the process of reducing health inequalities. We can see that in other areas, such as the provision of antiretroviral drugs to HIV-positive patients in Africa, and that has been completely transformed in the past decade. But he is right: while some countries have very underdeveloped health care systems, the risk of such public health emergencies is much higher and therefore the risk to the UK is higher.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

I should like to echo the tributes paid to our NHS volunteers and to all health workers. Today of all days, it is important to recognise the sacrifices that they make. The Secretary of State has indicated that Newcastle’s Royal Victoria infirmary in my constituency is next in line after the Royal Free to receive Ebola victims. Will he say a little more about what measures are or will be in place for public awareness, training, equipment, staffing and basic hygiene procedures to enable that to happen?

[Mr Hunt]

I am happy to let the hon. Lady have full details of what is being planned at the RVI, which is an excellent hospital. It was one of the hospitals that was part of the exercise that we did on Saturday to test preparedness. In that exercise, we modelled what would happen if someone became sick and vomited in the Metro centre and was then transferred to the RVI. We modelled the decisions about whether they would be kept there or transferred to the Royal Free, and so on. I am very satisfied with the measures in place at that hospital, but I will happily send her the details.

[Roberta Blackman-Woods (City of Durham) (Lab)]

I am one of a group of parliamentarians who returned from a visit to west Africa on Friday. We were quite surprised to be asked no questions about where we had travelled, and to be offered no screening at either the EU or UK border; I came back to Newcastle from Brussels. Will the Secretary of State reassure us that all regional airports will offer screening and advice to people who might be affected? Will he redouble his efforts, in partnership with other agencies, to stop the spread of this disease, which is devastating parts of west Africa?

[Mr Hunt]

We are absolutely redoubling our efforts, and we are looking at what screening procedures are needed at regional airports. The screening and monitoring procedures that I outlined are starting at Heathrow terminal 1 tomorrow; they will be rolled out progressively across Heathrow, Gatwick and Eurostar terminals over the next two weeks. We are satisfied that that will reach the vast majority of people travelling from the affected countries. Any decision to expand those arrangements to other regional airports will be taken on the basis of the scientific advice that we receive about risk.

[Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)]

Liverpool university’s Institute of Infection and Global Health, and the Liverpool School of Tropical Medicine, have done a great deal of work to address the problem of the transmission of Ebola. Does the Secretary of State’s work involve their recommendations, and do his proposals for combating Ebola, particularly as regards international travel, address the issues that those institutions raise?

[Mr Hunt]

The hon. Lady is absolutely right to say that we have fantastic research on the spread of infectious diseases at a number of institutions in this country, including in Liverpool, and we are not only using that research in the battle that we are leading in Sierra Leone, but making it available to partner countries leading the battle in other parts of west Africa. The advice that I get from my experts, from Public Health England and from the chief medical officer takes full account of the research done in places such as Liverpool.

[Kevin Brennan (Cardiff West) (Lab)]

In his statement, the Secretary of State said that the screening measures would reach 89% of passengers from the three affected countries; it is therefore hoped that one in 10 will self-identify. Will he tell the House the numbers that the estimate is based on, not just the percentage, so that we have an idea of how many people will be involved in these screening measures?

[Mr Hunt]

For the month that we looked at, September, we are talking about around 1,000 people arriving from the directly affected countries, which is about 0.03% of all Heathrow travellers for that month. It is important to say that the vast majority of those will be low-risk passengers, but those are the people with whom, initially, we would want to have a conversation, so that we could understand whether they had been in contact with Ebola patients or had been in the areas particularly affected by Ebola, and so that we could decide whether we needed to put in place tracking procedures to allow us to contact them quickly, should they develop symptoms.

[Heidi Alexander (Lewisham East) (Lab)]

The Secretary of State may be aware that this weekend Lewisham hospital dealt with a suspected Ebola case. Thankfully, tests have shown that the individual is free from the virus, but may I press the Secretary of State further on the advice given to staff on the NHS front line? When was the guidance to NHS hospital and general practitioner receptionists sent out, and what steps have been taken to ensure that the guidance has been read and understood, and will be acted on?

[Mr Hunt]

First, on what happened in Lewisham hospital, the moment the individual was identified as a potential Ebola case, he was put into isolation. We learned, from what happened there, the importance of making sure that the guidance is widely understood. Making sure that everyone on the NHS front line knows what happens is an ongoing process. It is important to say, as I did in my statement, that the chief medical officer is satisfied that the arrangements in place right now are correct for the level of risk. The additional processes that I talked about are to make sure that we are ready for an increase in that risk.

[Mr Iain McKenzie (Inverclyde) (Lab)]

Did I hear correctly that the Secretary of State said that 21 days is quite a lengthy time for the incubation of this particular disease? Will he commit to putting a further screening in place towards the end of that 21 days so that he can be assured that those entering the country are free of Ebola?

[Mr Hunt]

I am not sure that I entirely understood the hon. Gentleman’s question, but the incubation period is 21 days, so if we identify through the screening and monitoring process someone who is higher risk, we will want to stay in touch with them for that period of 21 days on a daily basis to make sure that we are monitoring their temperature and that we get help to them as quickly as possible if they need it.

[Mr Stephen Hepburn (Jarrow) (Lab)]

I welcome the introduction of screening at various London locations, but what about Newcastle, which runs numerous flights every day to the airports that act as hubs for these west African countries, and obviously there is passage that way?

[Mr Hunt]

The hon. Gentleman is absolutely right. We have numerous ports of entry to the UK. We are one of the most international countries in the world, and London is one of the most international cities in the world, so the actions that we take must be proportionate to the risk. The risk is currently low, so the advice is that having no screening procedures at those airports is proportionate to the risk now, but we are taking this precautionary approach, starting with the Heathrow, Gatwick and Eurostar terminals, because we want to prepare for a possible increase in that level. Were that to happen we would of course look at whether that screening process should be expanded to regional airports.

[Andy Sawford (Corby) (Lab/Co-op)]

In a recent film of medical workers treating people in west Africa with Ebola, a young doctor said that the one benefit of her protective mask was that people could not see her cry. Even as the media focus inevitably moves on, we know that this will go on for months and months, so will the Secretary of State give us all an absolute assurance that we will continue, even though we cannot see her cry, to hear her voice and do whatever we can to help people in west Africa?

[Mr Hunt]

If that is the last question today, it is a fitting one on which to end. The hon. Gentleman is absolutely right: this is an appalling human tragedy. There have been more than 4,000 deaths so far, in countries that are already, in many ways, the unluckiest in the world in terms of the levels of poverty that they already have to cope with daily. We can be incredibly proud of the 659 NHS volunteers, and the military, diplomatic and development staff who are stepping up to the plate, and we should always remember our humanitarian responsibility never to forget those countries’ plight.

NHS England and the NHS Outcomes Framework

Jeremy Hunt Excerpts

Tuesday 22nd July 2014 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today, I laid before Parliament my first “Annual Assessment of the NHS Commissioning Board (known as NHS England) 2013-14”. The “National Health Service Commissioning Board Annual Report & Accounts 2013-14” was also laid (HC408). Together they describe an organisation that has established itself and made progress in delivering the Government’s mandate, but has more to do to deliver all of its objectives. Copies of both documents are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

The mandate to NHS England sets the Government’s ambitions for the NHS as well as the funding available to achieve and deliver the care people need and expect. The Health and Social Care Act 2012 requires the mandate to be reviewed on an annual basis to ensure that it remains up to date.

It has never been more important to provide the NHS with stability and continuity of purpose than now. And that is why the Government proposes to uphold all of the existing objectives in the current mandate, and maintain a stable mandate for 2015-16, to enable the NHS to build on its achievements and make further progress on the ambitious agenda already set.

Meanwhile, the challenges facing the NHS and wider health and care system for 2015-16 remain, with an ageing population and an increase in the numbers of people with long-term conditions. We want to see the NHS make further progress in transforming primary care to improve services for older people and those with the most complex needs, and on delivering a system-wide response to the Francis inquiry recommendations, while from 2015-16 joining up health and social care through the better care fund will be key to transforming care.

Within the stable mandate, as part of its existing objective to make progress towards parity of esteem for mental health, NHS England is working with the Department to fulfil its commitment to develop a range of costed options for new access and/or waiting time standards for mental health services, in order to implement these standards starting from April 2015, with a phased approach depending on affordability.

The NHS has generally been performing well and meeting demand despite increasing pressure on services. A stable mandate will allow the NHS to focus on maintaining its performance in providing high-quality, compassionate, and joined-up care now and in the future.

In addition, this summer we will be reviewing the NHS outcomes framework. The review has two aims: to update the framework for 2015-16 by improving, adding and removing existing indicators, and to indicate a direction of travel for future indicator development. Reviewing the NHS outcomes framework this year is also an opportunity to increase alignment between the framework and the objectives in the mandate given the commitment to stability for the mandate for 2015-16.

We have been working closely with NHS England on the approach to the mandate and the review of the outcomes framework, and will be engaging with stakeholders over the summer, ahead of publication in the autumn.

NHS Modernisation (Costs and Benefits)

Jeremy Hunt Excerpts

Tuesday 22nd July 2014 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I announced in July 2013 that the costs of implementing policies in the Health and Social Care Act were likely to be closer to the estimate in the business case for the programme—£1.5 billion in today’s prices—rather than the £1.6 billion to £1.7 billion estimate reported in October 2012.

I can today confirm today that I am expecting the costs of NHS modernisation to be no higher than £1.5 billion.

Up to 31 March 2013, costs of £1,096 million had been incurred across the health and care system on developing and establishing the new arrangements. During 2013-14 organisations in the new system reported that they had incurred a further £220 million to continue this work. Some of these costs will relate to the continuous improvements that all organisations are expected to make. So, at most, the costs to 31 March 2014 were £1,316 million, comprising:

£456 million on staff redundancies;

£75 million on IT for the new organisations;

£88 million on estates costs of closing bodies and setting up new organisations;

£26 million on internal departmental costs—for example, programme management;

£323 million on setting up clinical commissioning groups—excluding items above; and

£348 million on other costs of closing bodies—for example, PCTs—and setting up new organisations.

In the impact assessment, long-term annual savings arising from the changes were estimated at £1.5 billion per year from 2014-15 onwards. Gross savings over the transition period—2010-11 to 2014-15—were estimated at £4.5 billion.

As I announced last year, annual savings are still expected to be £1.5 billion from 2014-15.

The reductions in administration costs up to 31 March 2014 are set out below. These are calculated on a basis consistent with the impact assessment for the Health and Social Care Bill—with the figures set aside any administrative spending on implementing the reforms.

Special Measures Regime

Jeremy Hunt Excerpts

Wednesday 16th July 2014 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With permission, Mr Speaker, I would like to make a statement about hospitals in special measures, and the next steps for rolling out a new inspection regime in the social care sector.

One year ago in the wake of the Francis inquiry, Professor Sir Bruce Keogh delivered his report into NHS hospitals with the highest mortality rates. Shockingly, he found that the poor care swept under the carpet for four years at Mid Staffs was not an isolated incident or “local failure” as some have claimed, and he recommended that 11 trusts should be placed into special measures. As a result of the new independent hospital inspection regime introduced by this Government, a further five trusts have been placed into special measures, taking the total to 16 trusts—more than 10% of all acute trusts in the NHS in England. Today I am reporting back to the House on the progress of the first trusts to be put into special measures, and on how the lessons we have learned can be applied to adult social care.

I would like to start by thanking all the front-line staff who have been involved in the special measures process, which can often be traumatic and stressful, with difficult media coverage in local and national newspapers. Thanks to their superb efforts, I am pleased to report today that progress is being made in nearly every trust and that the chief inspector of hospitals has recommended that five should now come out of special measures. Together with Monitor and the TDA—the NHS Trust Development Authority—he will shortly be publishing a report of his findings.

Across all the initial special measures trusts, leadership capability was carefully reviewed, leading to 53 changes at board level. A hundred more doctors and 1,300 more nurses and nursing support staff have been recruited. Every hospital has put in place a comprehensive improvement plan and was partnered with at least one other high-performing hospital, giving access to best practice and hands-on guidance and assistance.

The chief inspector and Monitor have confirmed that Basildon and Thurrock NHS Foundation Trust can leave special measures with no further support. Under Clare Panniker’s inspired leadership, the trust has appointed 241 additional nurses and has been given a “good” rating overall, with its maternity unit the first in the country to be rated “outstanding”. The chief inspector has recommended that George Eliot NHS Trust should also exit special measures, with a new acute medical unit, 31 more doctors and a strong partnership with University Hospital Birmingham NHS Foundation Trust.

The chief inspector and the TDA have confirmed that Buckinghamshire Healthcare NHS Trust, where there has been good progress on staffing, nutrition and hydration, should also leave special measures, with some continued support in place. The chief inspector has recommended that East Lancashire Hospitals NHS Trust, with some 238 more nurses and nursing assistants in place, should also exit special measures with some continued support. He has recommended that Northern Lincolnshire and Goole Hospitals NHS Foundation Trust should also leave special measures, with some continued support in place, having improved stroke care and employed 166 extra nurses and nursing assistants.

While United Lincolnshire Hospitals NHS Trust has made progress, including the employment of 140 additional nursing staff, work remains to be done, and the chief inspector has recommended that it should remain in special measures for a further six months. Turning around a hospital which had significantly high death rates going back to 2006 is a big task, but I know, having visited the trust myself, how much enthusiasm there is to exit special measures.

At North Cumbria University Hospitals NHS Trust, a further 90 nursing staff have been employed, and mortality is now within normal limits. However, the chief inspector has recommended that further progress is still needed, although we are hopeful that this will be completed within six months. At Tameside Hospital NHS Foundation Trust, while staff are reporting a better leadership culture and there have been improvements on some key safety indicators, he recommends a further six months in special measures to ensure that sustainable improvements really are in place.

The chief inspector continues to have strong concerns about Medway NHS Foundation Trust—an organisation with long-standing difficulties, care failures and high mortality rates going back to 2005. He recognises some progress, including the recruitment of 113 nurses, but has concerns about the sustainability of those improvements. He will make his recommendations about Burton Hospitals NHS Foundation Trust and Sherwood Forest Hospitals NHS Foundation Trust in the next few days, following their local quality summits.

All the Care Quality Commission’s recommendations will need to be fully considered by Monitor or the TDA before they are confirmed. I pay particular tribute to the work done by the chief inspector and his team from the CQC, and to Monitor and to the TDA, for the extraordinary effort they have put into making the improvements outlined above.

However, the responsibility for safe and compassionate care goes far beyond hospitals. Hundreds of thousands of people—some of the most elderly and vulnerable in our society—receive care in their own homes or in residential and nursing homes. Yet in recent years a member of the public, Jane Worroll, discovered from a secret camera that her mother was being systematically abused in Ash Court care home in London. Another secret camera filmed a resident being slapped and mocked at the Old Deanery home in Essex earlier this year. Perhaps most shocking of all was, in the words of the West Sussex coroner, the “institutionalised abuse” handed out to the residents of the Orchid View care home in Copthorne, where five people were found to have died as a result of poor care. The long list of failings included residents being left in soiled sheets, call bells ignored or left out of reach, and medications mismanaged.

Every older person has a right to be treated with dignity and respect in the way we would all wish for our own parents and grandparents. This Government are determined to see demanding standards and tough enforcement apply as much outside hospitals as inside.

Inexplicably, the previous Government scrapped expert-led inspections of adult social care organisations—as they did for hospitals. The same individuals, therefore, might have been inspecting a large teaching hospital and a small care home in the same week without any opportunity to develop the detailed expertise necessary to make important judgments.

Today I can confirm that we are bringing back expert-led inspections for adult social care, and I am encouraged that the new chief inspector of social care, Andrea Sutcliffe, has announced the toughest ever enforcement regime, to ensure that ongoing abuse and neglect in residential care homes and domiciliary care services is stamped out once and for all.

Alongside the new programme of rigorous and independent inspections, the CQC is being given the power to produce ratings of care providers that will provide a fuller picture of the quality of care than mere compliance with minimum standards. The first ratings will be published in October.

New fundamental standards of care will also be introduced, which will allow the CQC to prosecute those responsible for unacceptable care. In addition, we are introducing safeguards that will allow the CQC to remove and bar individual directors.

I can announce today that once in special measures, care services will be given six months to shape up or action will be taken that will lead to them closing down. This regime will start next April. From then, any care service rated as “inadequate” under the new ratings system will be required to improve within a time-limited period. The CQC will then take action to close down any services that do not meet the standards that people have a right to expect.

My Department and the CQC will work with the sector on the details of that framework, including what support can be given to failing providers and the timing of any closures. In particular, the CQC will work with people using services, their carers and their families to ensure that no one suffers as a result of any service closing down.

We are taking these steps because we have a moral duty to our most vulnerable people to ensure that they receive the best possible care and that they are treated with compassion, dignity and respect. We also owe it to those many excellent providers who deliver good care every day and need proper recognition.

When this Government took the tough decision to confront the reality of poor care within the NHS, people said we were running down the NHS and its dedicated staff. But we refused to accept a status quo that tolerated poor standards, betrayed NHS values and, most of all, betrayed hard-working staff who have given their lives to the care of others.

As a result, we are finally turning around performance in failing hospitals—something we are today extending to social care. Much remains to be done, but after a traumatic moment in its history, both the NHS and the social care systems have faced the truth, confronted the past, and can now face the future with confidence.

I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

Anyone who supports the NHS must always be prepared to shine a light on its failings so that it can face up to them and improve. Therefore, I welcome much of what the Secretary of State has said today, and I join him in thanking Sir Mike Richards and Sir Bruce Keogh. Their work builds on foundations laid by the previous Government, and I do not think the Secretary of State helps his case today by continuing to make assertions not supported by the facts. Let me once again gently remind him of the broader context.

It was following care failures in the 1980s and 1990s that independent regulation of the NHS was introduced for the first time by the previous Government. It was that independent regulator that, as Sir Bruce Keogh said, helped reduce mortality in all NHS hospitals over the past decade and then uncovered problems at Mid Staffs.

The Secretary of State was right to say that Mid Staffs needed to be a moment of change for the NHS. The central lesson of the first Francis report, which I commissioned, was that staffing levels were critical to safe care. The big question that arises is for this Government to answer: why, following that report, did they fail to learn the lesson and allow staffing to fall across the NHS in the first three years of this Parliament? Nurse numbers were cut by almost 6,000 in the three years between July 2010 and July 2013, but the cuts fell particularly hard on some of the 11 trusts that we are considering today. North Cumbria cut 148 nursing posts, United Lincolnshire cut 179 and Basildon cut 345. When the Health Secretary was forced to put those trusts into special measures, it was because they were getting worse on his watch.

The Health Secretary mentioned Basildon—like him, I congratulate the trust and its staff on its improvement—but I left a clear warning in place about Basildon in 2010, following a statement I made to the House. Why on earth was it allowed to cut so many staff in the following three years when Francis had already warned of the dangers of doing so? I have an answer to a parliamentary question that shows that Ministers did not hold a single meeting about Basildon up to its being placed in special measures, presumably because they were distracted with their reorganisation. Will the Health Secretary now admit that it was an error to cut so many nursing staff, and will he today accept the National Institute for Health and Care Excellence recommendations on safe staffing levels?

Let me turn to the special measures regime. We welcome the improvements at some of the 11 hospitals and pay tribute to the staff, but it is a concern that four are showing only limited signs of improvement. One trust, Medway, has barely shown any, but how can that be after a year in special measures? Does it not raise questions about whether the regime is providing enough support to improve? A CQC inspection published last week found a catalogue of concerns at Medway—patients on trolleys overnight without appropriate nursing assessment, medication given without appropriate identification of patients, and insufficient nursing levels with an over-reliance on agency staff. The Secretary of State claims that all the problems are long-standing ones, but the CQC found that happening right now. The trust has been in special measures for one year. How can there have been no improvement, what is he doing to help Medway to improve, and given its worrying lack of progress, will he report back to the House at the first opportunity?

There are also questions about the inspection regime. Last week, it was revealed that in 2012 the CQC employed as inspectors 134 applicants who had failed competency tests, of whom 121 are still in place. Again, how was that allowed to happen? Is the Health Secretary confident in the ability of those inspectors, and if not, what is he doing about it?

Three of Cumbria’s four largest hospitals are in special measures. General practitioners are under severe pressure, and my hon. Friend the Member for Copeland (Mr Reed) relayed their warnings to the House yesterday. Is there not a much wider failure in the health economy, as he warned, and with an overly hospital-focused inspection programme, is there not a risk that wider problems in the heath economy are being missed? Is it not the case that hospitals are often dealing with pressures and problems not of their own making—but due to cuts to primary care, social care or mental health—and to be truly effective, should not the Health Secretary’s inspection regime take a much wider view of the whole health economy?

That brings me to social care, about which the Health Secretary is right to say that we have seen appalling failures in recent years at Winterbourne View, Orchid View and Oban Court. We welcome the extension of the special measures regime to care homes, but I must say that it sounds like a U-turn. Only recently, he legislated to remove the CQC’s role in assessing whether councils commission care effectively. Is he conceding that that was a mistake, and does he accept that it must be reversed if we are to have truly effective care inspection?

Local authority commissioning can be the root cause of care failures, but so can the impossible budget cuts that many providers now have to absorb. Is that not the real reason why we have such problems in our malnourished social care system today? New House of Commons Library analysis—we are publishing it today—shows that £3.7 billion has been cut from adult social care since 2009-10. That is not sustainable. How does the Health Secretary think that older and disabled people will ever get the standards of care to which he aspires with cuts on this scale?

The truth is that the collapse of social care is in danger of dragging down hospitals, which are becoming dangerously full of older people and struggling to function. The Health Secretary will not like to admit it, but in the year to the day since he stood at the Dispatch Box and made his first statement on the Keogh report, hospital accident and emergency departments have missed his own lowered A and E target in every single one of those 52 weeks. Does that not tell us more clearly than anything that it is not just a small number of trusts that have got worse on his watch, but the whole NHS? The cancer treatment target has been missed for the first time ever, it is harder to see a GP, and waiting lists have hit a six-year high. He does not just need a plan for some trusts; he urgently needs a credible plan to get the whole NHS back on track.

[Mr Hunt]

I had hoped for a little more consensus on the issue of dealing with poor care. I am afraid that what we had from the right hon. Gentleman was a set-piece speech. However, let me go through the points that he raised.

First, the right hon. Gentleman spoke about nursing numbers. Let us look at the number of nurses since the Government took office. We have 6,200 more nurses on our wards than when he was Secretary of State for Health. Why is that? It is because we took the difficult decision, which he opposed every step of the way, to get rid of the bureaucracy, the primary care trusts and the strategic health authorities—19,000 administrators—so that we could afford more nurses, more doctors, more paramedics and more front-line staff. It is time that he admitted that he was wrong to oppose those important reforms.

The right hon. Gentleman then talked about trusts missing A and E targets. Despite the fact that we are doing better on A and E than he did as Health Secretary, he has missed the point about targets. It was an obsession with targets under Labour that led to the problems in Mid Staffs and many of the trusts that are in special measures today. Let us just take one example. [Interruption.] The Opposition should listen to this example because it provides an important lesson about targets that the Labour party has still not learned. Buckinghamshire had a terrible tragedy in 2004 and 2005, when more than 30 pensioners died in a clostridium difficile outbreak. Why did that happen? The independent report said that the trust was too focused on Government targets.

That is the dividing line. The Opposition want an NHS that is obsessed with targets. The Government recognise that targets matter, but that treating people with dignity, respect and compassionate care matters. Is it not extraordinary that the party that founded the NHS has got itself into a position where it does not care how people are treated in the NHS?

The right hon. Gentleman talked about social care. If he wants more funding for social care, why has he called for the better care fund to be halted, when it will put an extra £1.9 billion at the disposal of the people who commission adult social care?

Let us look at some of the examples that the right hon. Gentleman raised. He talked about Basildon. When he was Health Secretary, the CQC sat on a report about that trust for six months that talked about bloodstains on the carpets, blood on the floors and vital safety measures being ignored. When the reason why the report was not published for so long was looked into, people at the CQC said that they were afraid to publish something that could embarrass the Government of the day. Is it not time that he admitted that the way the Labour Government ran the CQC was wrong? We now have an independent inspections regime, which is a big step forward.

The right hon. Gentleman talked about Cumbria. There are real issues in some of the hospitals in Cumbria. However, when Labour was in office, somebody in one of those hospitals—North Cumbria—was paid £3.6 million because they were disabled for life. Should that not have been a warning sign? There were also issues at Morecambe Bay involving children.

[Mr Jamie Reed (Copeland) (Lab)]

What are you doing?

[Mr Hunt]

What are we doing? We are doing what I set out in the statement. We are putting more nurses and doctors into hospitals that are in special measures. We are turning around the failing hospitals that Labour swept under the carpet.

Even if Labour has not understood the lessons of Mid Staffs, the NHS has. We have 6,000 more nurses; five hospitals are out of special measures; there is record public confidence in safe and compassionate care; and, from today, we have new plans to stamp out poor care in adult social care. When everyone in the NHS is so keen for those plans to work, is it not time that Labour ended its denial about the past and backed them as well?

[Margot James (Stourbridge) (Con)]

I congratulate my right hon. Friend on bringing back an expert-led inspection regime for adult social care. I ask him to learn from the experience with schools in Birmingham five, six or seven years ago, which managed to bamboozle Ofsted by planning for the inspections. I ask him to ensure that a good proportion of the inspections under the new regime have no notice whatsoever.

[Mr Hunt]

My hon. Friend, as ever on health issues, makes an extremely important contribution. She is right that we drew a lot of inspiration from the Ofsted regime, which is clear, transparent and easy for the public to understand. She is right that snap inspections are importation. I reassure her that the CQC has the power to perform snap inspections. It has already used that power and will continue to do so.

[Mr Jack Straw (Blackburn) (Lab)]

Does the Secretary of State agree that it is a tribute to the new leadership of Professor Eileen Fairhurst, the chair of the East Lancashire Hospitals NHS Trust, the other senior clinicians and managers, and the vast majority of staff at the trust, who are of a high quality, that the trust has been able to turn around and get out of special measures? Does he also accept that, as Professor Sir Bruce Keogh makes clear—these are my words, not his—it is essential that the trust does not take its foot off the gas, but continues the process of change and, above all, cultural change in the way that patients are treated? Lastly, although the additional nurses are welcome, will he say something about the implications for the future funding of the trust?

[Mr Hunt]

The right hon. Gentleman makes some important points. I will start with the point that provides a broader lesson for the NHS. Not taking our foot off the gas is really important. This is the start of a very long journey. I said last year that it would take about three years to turn around a hospital where the wrong culture has become entrenched.

I pay tribute to the leadership at East Lancashire Hospitals NHS Trust. The CQC report said that the staff on the front line now feel more supported, more empowered to take decisions and more able to raise concerns. If there is one thing that we have learned, it is that successful hospitals make it easy for their staff to speak out and support them in speaking out. The hospitals with problems are the ones where people feel bullied and intimidated when they speak out. I am delighted with the progress that has been made.

In respect of finances, this is a challenging time for finances across the NHS. I simply say that, as I am sure the leadership of the right hon. Gentleman’s trust recognise, the most expensive thing of all is delivering poor care. The most important way of saving money is ensuring that the care that is delivered is safe.

[Paul Burstow (Sutton and Cheam) (LD)]

I very much welcome the changes the Secretary of State has announced on social care inspections. However, standards and enforcement alone are not sufficient. Does he agree that we need to look at the support that is provided to organisations so that they can change before they get to a point of crisis? If so, will he look at the work of My Home Life, which runs programmes to transform the lives of people in care homes and improve their quality of life by working with staff in a different way? I commend that work and hope that he looks at it.

[Mr Hunt]

I am happy to do that. I agree with the right hon. Gentleman. I would like to see a lot more innovation. Even in the best care homes, which deliver good care by today’s standards, there is room for much more innovation and imagination in seeing how we can make people’s last years ones that they really enjoy. I have seen some amazing dementia care homes that break the mould. I am very happy to look at the work of that organisation. I am sure that there is a lot we can all learn.

[Mike Gapes (Ilford South) (Lab/Co-op)]

The Secretary of State said that 16 trusts are in special measures, but he mentioned only 11 of them. As he knows, Barking, Havering and Redbridge University Hospitals NHS Trust includes King George hospital in my constituency. Will he take this opportunity to explain why he has not said anything about that trust? Is it because the plans to close the A and E this year or next year are in total disarray, but he does not want to admit it publicly? Will he take this opportunity to clarify—yes or no—whether it is still his intention that King George hospital’s accident and emergency will close?

[Mr Hunt]

First, let me reassure the hon. Gentleman on the last point. The trust has made it absolutely clear that the change in A and E will not happen until it is safe. It is very unlikely that it will happen in the near or medium term. The reason I did not mention his trust is that the statement was about the 11 trusts that were put into special measures exactly a year ago and his trust was not put into special measures until just before Christmas. It, too, is making progress. It has employed 31 additional nurses, it has an excellent chief nurse, whom I have met on a number of occasions, it has had a new chief executive since April and there is an increase in patient satisfaction. However, there is still a long way to go because it is a very challenged trust with some deep-seated problems. We need to support it at every step of the way.

[Jeremy Lefroy (Stafford) (Con)]

Today’s statement and the appointment of the chief inspector of hospitals arise from the Francis report on Mid Staffs in my constituency. I am sure my right hon. Friend acknowledges the great improvements that have been made at Mid Staffs thanks to the hard work of staff and others, but he will also acknowledge that the situation remains fragile. Will he ensure that both Stafford and the University Hospital of North Staffordshire are given the full support they need to come together and implement the recommendations of the trust special administrators in full, as a minimum?

[Mr Hunt]

I pay tribute to the staff in Stafford hospital. I also make the point that, even through the four years when those terrible examples of care happened in the hospital, much excellent care was happening, too, and the hospital had dedicated and hard-working staff. This has probably been tougher for them than for anyone else in the whole NHS. I thank my hon. Friend for the way in which he has campaigned for his local hospital. No one could have done more for their local services. I agree with him that we must implement the very detailed recommendations of the TSAs quickly and in full, and ensure that we give every bit of support necessary to both Stafford and UHNS to ensure that that merger works.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The Health Secretary talked about denial of the past, but that was a bit rich given that Conservative Ministers gave Jimmy Savile a managerial post at Broadmoor. He wants to think about that a bit more.

In view of the disgraceful care failures the Health Secretary detailed, I find it surprising that he relies on inspection to raise standards and ignores the obvious impact of cuts of £3.7 billion in social care budgets. Does he not see that inspection will not fix the parlous state of social care?

[Mr Hunt]

I am afraid that that is the difference between Government and Opposition Members. The hon. Lady says that there was denial over Jimmy Savile, but I stood at this Dispatch Box and apologised to relatives and members of the public for the mistakes relating to Jimmy Savile. I do not call that denial; I call it facing up to the past.

Of course, inspection is not the only answer, but the reason it was so wrong to abolish the expert-led inspections we used to have in social care is that the first step, if we are trying to improve standards, is at least to know where the problems are. Until we have those expert-led inspections, we will not know that. The next step is to work out how to solve the problems. We will be doing both.

[Mr Henry Bellingham (North West Norfolk) (Con)]

The Queen Elizabeth hospital in King’s Lynn serves my constituency and that of the Secretary of State’s deputy, the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb). Will the Secretary of State pay tribute to the superb acting chief executive, Manjit Obhrai, and the former acting chairman, David Dean, who have done a sterling job, along with the hard-working staff, on the hospital’s comprehensive improvement plan? When will that hospital come out of special measures, and will he pay tribute to the excellent work that has been done in the past few months?

[Mr Hunt]

I am happy to do so. The hospital has recruited 95 more nurses and nursing support staff since last July. It has appointed a director of nursing and a medical director and lead for patient safety, which strengthens clinical leadership. Some very important changes have been made, and I pay tribute to the hospital’s leadership for making that possible. I hope my hon. Friend understands that, under the new system we have set up, it is not for the Secretary of State or any Minister to say when a trust is ready to come out of special measures. We have deliberately given that judgment to an independent chief inspector, so that no one who has a vested interest or a hope that a hospital will come out of special measures, and no one who is involved in turning around a trust, is responsible for that important independent judgment. However, that means that, when hospitals come out of special measures, people can have confidence that the judgment has been correctly made.

[Grahame M. Morris (Easington) (Lab)]

This is an important statement, but it is regrettable that the Health Secretary is implying that the care failures were all the fault of the previous Government. Will he confirm that Sir Bruce Keogh, who gave evidence to the Select Committee on Health yesterday, and not the Secretary of State, decided which hospitals would be placed in special measures? I understand that Sir Bruce’s decision was based on those hospitals being outliers for two consecutive years. According to my maths, that means that the failures described by the Secretary of State occurred on this Government’s watch. If he is apologising and feeling contrite, would he like to own up to that failure?

[Mr Hunt]

The examples of poor care I gave happened under this Government. I am therefore being absolutely clear that failures in care happened under both the previous Government and this one. The difference is that this Government are doing something about it. We are taking action and taking the difficult steps to get those trusts out of special measures. The public are beginning to have confidence that, when there are problems, they are not being swept under the carpet but being dealt with.

[Charlotte Leslie (Bristol North West) (Con)]

Bad care is unacceptable, but what turns bad care toxic is covering it up and denying that it is happening. I am pleased that we are beginning to get a consensus across the House that transparency and unearthing problems is the beginning of solving them. On that note, will my right hon. Friend the Secretary of State work on a cross-party basis with the right hon. Member for Leigh (Andy Burnham) and the Labour party on Wales, which was also targeted by Bruce Keogh’s expertise? He has suggested that it would be sensible to have a Keogh-style investigation in Wales, not only because of mortality statistics and diagnostic waiting times, but because tales coming to me and the right hon. Member for Cynon Valley (Ann Clwyd) are raising the alarm. I urge hon. Members on both sides of the House who are worried about patients in Wales to urge such an investigation there, because the investigation here unearthed problems.

[Mr Hunt]

I totally agree with my hon. Friend. It is an absolute tragedy for people who use the NHS in Wales and Welsh NHS workers that they are not getting the support that people in England get to deal with poor care. For some reason, the Labour Administration in Wales believe that it would be incredibly embarrassing to find problems, but that is what hospitals and hospital staff are crying out for. The staff did not go into those jobs to deliver poor care. They want the support to deliver the best care. It is time that Labour in Wales understood that and got the support of Labour in England to do so.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

The Secretary of State will know that the local MPs covering Tameside hospital have never pulled their punches in calling for the need to improve our local hospital. He may recall that we publicly called for the previous leadership of our hospital to be removed even before the Keogh review process began. Speaking on behalf of my hon. Friend the Members for Denton and Reddish (Andrew Gwynne), who sits on the Opposition Front Bench, and my hon. Friend the Member for Ashton-under-Lyne (David Heyes), we are disappointed that Tameside remains in special measures, but we believe that progress has been made, particularly in A and E and with regard to mortality rates. We believe that the new management team, who have brought about those changes, deserve our support. We will never accept anything but the very best care in Tameside, and we agree that there is more to do, but we believe we are on a journey of improvement and that our hospital is in a different place from where it was 12 months ago.

[Mr Hunt]

I thank the hon. Gentleman for the tone of his comments and totally agree with his sentiments. Tameside has recruited 70 new nurses and nursing staff. To take one important indicator—it is only one—the number of falls has decreased by 18%. The staff definitely feel more supported by the management. However, he is right that this is a long process—the trust has been troubled for many years—and we are absolutely determined to back the staff and get them over the line.

[Mark Reckless (Rochester and Strood) (Con)]

Mortality rates at Medway are not as elevated as they were in 2005, but does the Secretary of State believe that the astonishingly well paid interim managers have made any sustainable improvements, and will he expand on how University Hospitals Birmingham will help us to drive improvements at Medway?

[Mr Hunt]

To be frank with my hon. Friend, the situation at Medway is still troubling. It has made some improvements to maternity services and has about 100 more nurses, and the dementia unit has made progress, but we have not had the stability of management and leadership that will be necessary to sustain improvement. It always takes a very long time to make such improvements. We will therefore work hard to do that. I hope that the partnership with UHB will be a part of that change, because Julie Moore is one of the best chief executives we have in the NHS. I will work closely with my hon. Friend, because I know he takes a great interest, to ensure that we get the lasting changes we need at Medway.

[Graham Jones (Hyndburn) (Lab)]

Sir Bruce Keogh focused on the A and E at Royal Blackburn, which I have had the privilege of visiting. However, Hyndburn faces significant NHS cuts, such as cuts to the walk-in centre, which 36,000 people have been through; cuts to the NHS GP practice in Accrington Victoria; and cuts to personal medical services GP contracts, which GPs are deeply concerned about, and which will lead to a reduction in hours. GPs tell me that that will impact on A and E. Is the shadow Secretary of State right to say that we should look not only at hospitals, but at the broader picture, if we are not to neglect patients and let them down?

[Mr Hunt]

If the hon. Gentleman is worried about cuts, perhaps he might talk to the shadow Secretary of State and ask him why he said it was irresponsible for us to increase the NHS budget as we did.

On the particular issue the hon. Gentleman raises, I actually agree with the shadow Secretary of State. It is not always possible to solve these problems simply by reference to the institution. Sometimes we have to look at the broader health economy. That is particularly true of A and E, but it is true for many other parts of the NHS too. Where there is a broader health economy issue we must look at that as well, but this process means that Ministers are held to account for finding a solution, whatever that solution is.

[Martin Vickers (Cleethorpes) (Con)]

I join my right hon. Friend in his tribute to the front-line and managerial staff at North Lincolnshire and Goole NHS Foundation Trust. My constituents will particularly welcome the increase in staffing levels and the improvements in the stroke unit, which has been a particular concern. He will be aware of recent public criticism of the hospital trust by North Lincolnshire clinical commissioning group. Can he assure my constituents that the continuing help and support will focus on the aspects of its criticism?

[Mr Hunt]

That certainly needs to happen. I visited my hon. Friend’s trust and saw a knee operation. I talked to the staff about the special measures regime, and they said that they thought important changes were happening, so I was delighted too when they came out of special measures. We will certainly give all the support they need, and I thank him for the support he is giving his local hospital.

[David Heyes (Ashton-under-Lyne) (Lab)]

Does the Secretary of State agree that possibly the single most important factor in turning these hospitals around is the quality of the leadership? He has referred already to Tameside hospital, where the report talks of the staff reporting a better leadership culture. This hospital has suffered for far too long from inadequate leadership. I am confident that good leadership is in place now. The change in the hospital is palpable. I am confident that, given a fair wind, it can be out of special measures within the six months referred to, despite the severe underfunding with which the hospital management is grappling daily.

[Mr Hunt]

Funding pressures are everywhere in the NHS, but I agree with the hon. Gentleman’s sentiments that this is largely about leadership. As well as this work, we are working with Sir Stuart Rose to try to understand what we can better do to sustain and support the highest quality leadership. We have some great leaders in the NHS, but we probably do not have enough of them. I think there has been an improvement at Tameside. I strongly welcome that and we will certainly be supporting the leadership and the staff in that hospital every step of the way.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

I congratulate my right hon. Friend on his statement. I, too, congratulate Clare Panniker on her inspirational leadership at Basildon hospital. She informs me that rather than cutting 345 nurses between 2010 and 2013, there were 1,908 in 2010, 2,000 in 2013 and that that number is now up by 241. Does he agree that to tackle problems in the NHS we need honesty and accuracy when discussing these issues?

[Mr Hunt]

We do. I think it is time that those on the Opposition Front Bench, in particular, recognised that they were wrong to oppose so bitterly the move to get rid of 19,000 administrators in the NHS, so that we can afford 7,000 more doctors and 4,000 more nurses across the whole NHS. That has made a huge difference to the statement we are making today.

[Helen Jones (Warrington North) (Lab)]

The Secretary of State is right to say that abuse should never be tolerated, but does he not also accept that many of the problems in residential care for the elderly stem from a system that is trying to make profits out of the running of homes that are grossly underfunded because of the cuts his Government have imposed, and which, despite having some excellent staff who do their best, rely largely on untrained and underpaid staff? When is he going to tackle the real problems at the heart of the system, as well as announcing inspection regimes?

[Mr Hunt]

I do not accept that all profit-making organisations are going to deliver poor care. There are some excellent ones and some bad ones. Poor care is poor care wherever it exists. The hon. Lady is right to say that we need to value more the staff who work in residential care homes and domiciliary care services. They do a fantastic job that is often not well paid. The best thing we can do for them is to make sure that, where they are in an organisation that delivers poor care, we shout about it and talk about it, so that people find out about it and something gets done.

[Mr Robin Walker (Worcester) (Con)]

More nursing staff and a rigorous focus on care for the person, as well as an improved inspections regime, are very welcome, but does the Secretary of State agree that we also need to focus on sharing best practice and innovative approaches to care, such as those being pioneered at the Association for Dementia Studies at the university of Worcester?

[Mr Hunt]

We absolutely do need to do that. Dementia care is an area where there needs to be lots more work and innovation. There is huge variation and even some very caring places could try new ideas. There are some very interesting ideas about dementia care in Holland, too. I absolutely welcome that work.

[Derek Twigg (Halton) (Lab)]

Does the Secretary of State think that standards could be improved further by having minimum levels of staffing in care homes, and does he think that more can and should be done to improve pay and rewards for care workers?

[Mr Hunt]

We have recommended levels of staffing, but in the NHS we have decided not to have minimum levels of staffing. We were worried that that would be seen as a hurdle where, once achieved, nothing more would need to be done about staffing levels. The real issue about staffing levels and mandating numbers from the centre is that care needs change on a daily basis depending on how complex the needs are of the patients in a particular ward or home. That is why it is difficult to do it from the centre. We want to make sure that everywhere has the right numbers of staff. That is why I hope the hon. Gentleman welcomes the fact that we have so many more nurses.

[Dame Angela Watkinson (Hornchurch and Upminster) (Con)]

Barking, Havering and Redbridge University Hospitals Trust is working really hard to get out of special measures. We have a new chief executive and a new chairman who are paying particular attention to the recruitment of nurses and improving the efficiency of the appointment system. Will my right hon. Friend join me in congratulating Barking, Havering and Redbridge Trust on improving the level of patient satisfaction by four points?

[Mr Hunt]

I am very happy to do that, and I pay tribute to the leadership of the trust. There is a new chief executive and, as I have said, I have met the chief nurse. It is a very large trust with two big hospital sites. There are some very big challenges to tackle, but they are making important progress, and, like my hon. Friend, I am keen to get them out of special measures as soon as we can.

[Joan Walley (Stoke-on-Trent North) (Lab)]

Having read the Care Quality Commission annual report and met the CQC, and seen in the report that in Stoke-on-Trent more than 20% of care homes have not been fit for purpose for a period of more than three and four quarters, may I welcome the inspection regime of care homes? Training and enforcement will be important.

May I refer back to the comments made by the hon. Member for Stafford (Jeremy Lefroy) in respect of Mid Staffordshire Trust and Stafford hospital, and to previous meetings we have had with the Secretary of State, his colleague in the House of Lords and the Prime Minister and say that, between now and September, we need to know categorically from the Treasury whether the Government are going to fund in full what the University Hospital of North Staffordshire trust says it will cost to run the new configured hospital services across the whole of north Staffordshire? Only when that happens can the Government say that they have solved the issues relating to Mid Staffordshire.

[Mr Hunt]

I thank the hon. Lady for her support for the new special measures inspection regime for care homes. With respect to the merger of UHNS and Mid Staffs, we will make sure that the funding is available that is necessary for that merger to happen. Money is not the issue. The issue is doing what the TSA asked to be done quickly and in full, and making sure that we have the right leadership across both hospitals on a long-term sustainable basis. I do not think it is about money; it is about taking rapid action to make sure there are stable services and that there is continuity of care.

[Mr Marcus Jones (Nuneaton) (Con)]

Will my right hon. Friend join me in congratulating the staff at George Eliot hospital on their hard work in the past year and on the excellent result they achieved in the CQC review? Does he acknowledge that we need to do more at George Eliot to keep that improvement going and agree that we have now built a very strong platform on which to build the future of George Eliot as an important district general hospital in my constituency?

[Mr Hunt]

I agree with my hon. Friend on both points. We have seen 31 more doctors there since special measures, 52 more nurses, a new acute medical admissions unit and better flow throughout the hospital, reducing the number of moves that patients make between wards during their stay, so lots has been done. When I did a stint in the A and E department at George Eliot, I was very well looked after by the nurses there, but they told me how bad the IT systems were—I think they said there were 16 different IT systems in the hospital—and how they were constantly filling out new forms. I therefore hope that the partnership with University Hospitals Birmingham, which has one of the best hospital IT systems in the country—a fantastic system, developed by the trust itself—will mean that George Eliot can move to having really good IT, so that nurses have more time with patients, which is what they want.

[Bill Esterson (Sefton Central) (Lab)]

The Secretary of State spoke earlier about the need to value staff who work in residential homes. I presume he meant by that people who care for vulnerable, elderly and disabled people in their own homes as well. I completely agree with that, and he knows that we have discussed many times in the House issues such as the 15-minute time slots and the lack of reimbursement for the travel costs that people who care for elderly or disabled people have to bear. Does he agree, therefore, that unless we address issues such as the pay and conditions of staff, whether in residential homes or in people’s own homes, we will struggle to recruit and retain the very best staff, whom we desperately need to look after our vulnerable people?

[Mr Hunt]

I agree with the hon. Gentleman that we need to value staff who work in the social care sector much, much better. I think they do a fantastic and very difficult job for what is not high pay at all, so I recognise that issue. I also agree with his concern about 15-minute slots. I find it hard to believe that anyone can really do everything they need to when visiting someone who is frail or vulnerable in their own home in just a 15-minute slot. The new inspection regime will look at that and if it is unsatisfactory, it will say so.

[Several hon. Members]

rose—

--- Later in debate ---

[Mr Hunt]

Such reports will be used. Members of the public will be involved in the inspection regime and the way that care homes respond to complaints and concerns raised by families will be an important part of what the new chief inspector looks at.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

We all hope that the special measures regime speeds up the improvements that are needed in Morecambe Bay hospitals, but does the Secretary of State accept that the turmoil that those hospitals have been in for years now will never properly end until the Government recognise that the trust simply cannot deliver services with the same level of funding, given the almost unique challenges of rural isolation, severe deprivation and health need in the area?

[Mr Hunt]

I thank the hon. Gentleman for the work he has done with James Titcombe on the tragedy that happened at Morecambe Bay. I think there are particular issues in that trust owing to the fact that it is on two sites that take a long time to travel between geographically. The point of the new regime is to ensure that those issues get surfaced and that Ministers and the system have to address them. I hope that that is what will happen.

[Robert Jenrick (Newark) (Con)]

We await the report from Sherwood Forest Hospitals Trust with interest. Improvements have been made there, certainly in staffing levels, with the number of nursing staff rising significantly since the hospital trust went into special measures. However, one of the impediments to change at the trust is the terrible legacy of the private finance initiative, which is taking up 15% to 20% of the trust’s annual budget—something like £45 million. Is there anything more we can do to assist trusts in special measures that have a crippling legacy of PFI?

[Mr Hunt]

That is certainly something we keep under constant review, because it is a particular issue in some trusts. I would like to pay tribute to the progress made in Sherwood Forest trust—and in Newark hospital, which I know my hon. Friend has campaigned for—and to mention that it has an excellent chief executive, who has done a very good job in challenging circumstances.

[Nic Dakin (Scunthorpe) (Lab)]

I would like to pay tribute to the staff team at Northern Lincolnshire and Goole Hospitals Trust for the progress they have made, which has resulted in the trust moving out of special measures, but there is still much more to do. How will the Secretary of State ensure that the funding challenges faced by the local health service do not get in the way of making the further progress that is necessary?

[Mr Hunt]

Good progress has indeed been there, including centralising stroke services in Scunthorpe. There are funding pressures everywhere. What I would say about funding is that I do not want to run away from the fact that money is tight throughout the NHS, but lots of places are delivering safe, compassionate care even with those funding constraints. In fact, when we look in detail, we see that less safe care is the most expensive, so what we are doing should help trusts such as the hon. Gentleman’s to deliver safer care.

[John Stevenson (Carlisle) (Con)]

May I reiterate my support for my right hon. Friend’s policy of putting patients at the centre of the NHS? Clearly I am disappointed that North Cumbria Trust continues to remain in special measures, particularly given the hard work of the staff and management there. However, will the Secretary of State assure me that if the trust, with the support of Northumbria, produces a robust action plan to address the issues that have been raised, a re-inspection by the CQC can happen sooner rather than later?

[Mr Hunt]

No one is keener than my hon. Friend and I to get the trust out of special measures as quickly as possible, and I thank him for the many representations he has made with respect to North Cumbria. I know that the trust is disappointed not to come out of special measures, but it is now rated good in terms of being caring, and the CQC said in July that the staff were supportive to patients and those close to them, so some encouraging things are happening at the trust, and we will do everything we can to help it to go the final furlong.

[Andrew Stephenson (Pendle) (Con)]

I very much welcome the progress that has been made at East Lancashire hospitals. Following action by the Secretary of State last year, the trust has now recruited more than 200 new nurses, nurse support staff and consultants. In March, a new state-of-the-art £9 million urgent care centre at Burnley was officially opened to the public, replacing the old A and E department, which was downgraded under Labour in 2007. Given that poor performance at the trust was established back in 2005 and that the last Government failed to act on it, how can we ensure that future problems are addressed speedily, rather than being hushed up?

[Mr Hunt]

I thank my hon. Friend for his interest in his local hospital and I agree with him that the trust has made good progress. There is a simple way to ensure that these things get acted on quickly and that is to make sure they are public. When things are public—when they are transparent and everyone knows about them—the NHS and Ministers have to act, and that is the purpose of this system.

[Bob Stewart (Beckenham) (Con)]

Will my right hon. Friend confirm that if someone dies or is hurt in a residential care home, the directors of that home will also be held culpable under law?

--- Later in debate ---

[Mr Hunt]

Absolutely, and I think we have legislated to make that the case.

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

With reference to University Hospitals of Morecambe Bay NHS Foundation Trust, which has just gone into special measures, may I reassure the Secretary of State that the CQC has seen some improvements there delivered by front-line staff, particularly at Royal Lancaster infirmary? However, I want to underline what the hon. Member for Barrow and Furness (John Woodcock) said about the unique geographical problems facing a trust with four hospitals separated by hundreds of miles of sea, mountains and valleys.

[Mr Hunt]

I absolutely recognise that issue, which is something we will have to think about in terms of the long-term sustainability of the trust. Let me reassure my hon. Friend and the hon. Member for Barrow and Furness that the CQC chief inspector will not say that a trust can come out of special measures unless he can see a long-term sustainable future for that trust, so part of the purpose of the regime is to force everyone in the system to confront those issues so that we bite the bullet quickly.

[Andrew Percy (Brigg and Goole) (Con)]

The positive progress of the Northern Lincolnshire and Goole NHS Foundation Trust is to be welcomed and is a direct result of the work of health care assistants, nurses and doctors. On the issue of social care, may I commend North Lincolnshire to the Secretary of State and ask him perhaps to visit again? The local council has not only refused the request by the Labour opposition on the council to cut social care in the budget, but has actually increased funding for elderly and disabled people by £1 million in this year’s budget and is opening up a network of well-being centres to support older people in their own homes, as well as constructing a £3.2 million intermediate care facility, so that a lot of our residents do not have to go into hospital in the first place.

[Mr Hunt]

I thank my hon. Friend for the warm welcome he gave me when I visited the trust—including the visit to a not particularly healthy, but delicious bakery as part of the trip. I welcome what is happening in social care, and I think it is something on which we can agree at the national level across the House—that cuts in social care can be very counter-productive, leading to more pressure on the social care system and more pressure on the NHS.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Adam Holloway (Gravesham) (Con)]

1. What progress his Department has made on improving primary care for frail older people.

[The Secretary of State for Health (Mr Jeremy Hunt)]

It is a particular pleasure to be here this morning, although I appreciate that that feeling may not be reciprocated on all sides of the House.

Our NHS will not be sustainable unless we totally transform out-of-hospital care. That is why we have introduced the £3.9 billion merger of the health and social care systems, and reforms to the GP contract. We are encouraging clinical commissioners to be responsible for all out-of-hospital commissioning.

[Mr Holloway]

I am delighted that my right hon. Friend is answering questions today. Will he confirm that the changes announced will mean that frail elderly patients in Gravesham will have a single person to co-ordinate their care?

[Mr Hunt]

There is agreement across the House that we need a focus on frail elderly patients and a system in which everybody knows, for their mum, dad or grandparents, that there is someone in the NHS where the buck stops in relation to complex, long-term conditions. That is a condition of the better care fund, so I hope that that will make a big difference in my hon. Friend’s constituency.

[Alison McGovern (Wirral South) (Lab)]

The Secretary of State mentioned integration. Good care and support for older people in their own homes are vital, yet a constituent visited me recently to say that she simply could not find a decent trustworthy care company to look after her relative. Will the Secretary of State join me in calling for all local authorities to sign up to the ethical care charter?

[Mr Hunt]

I do not know what the charter says, but I am happy to have a look at it. I agree with the hon. Lady’s sentiments. The important change we need to make is to understand that it is a false economy not to look after people who are vulnerable—those who need help washing, getting out of bed and feeding every day. Scrimping on such care is incredibly dangerous: it costs the NHS more, but most of all it means that those people are not treated with the dignity and respect that they should be.

[Greg Mulholland (Leeds North West) (LD)]

A recent Age UK report shows that older people are many times more likely to be moved multiple times in hospital, and that there is an attitude that they should not be using up hospital beds. What does my right hon. Friend suggest to tackle the problem, for example through improved guidance?

[Mr Hunt]

The attitude to which my hon. Friend refers is totally unacceptable. It is not specifically an NHS problem; we need to change the way of thinking across our society. In particular, I worry about people with dementia who are sometimes in hospital wards where they are not able to speak up for themselves. That is why we have introduced probably the toughest inspection regime of any hospital system anywhere in the world, and I hope it will make a real difference.

[Ms Margaret Ritchie (South Down) (SDLP)]

In view of the fact that there are currently 10 million people in the UK over 65, and the latest projections are for a further 5.5 million elderly people in 20 years’ time, what plans have the Government made to allocate and prioritise resources for the future care of older people with complex needs?

[Mr Hunt]

The hon. Lady is absolutely right. The figure always in my mind is that by the end of the next Parliament we will have more than 1 million additional over-70s. We need to totally change the way we look after those people, through the single point of contact and a different attitude to continuity of care. One of the things that matters most to those people is the feeling that there is someone in the NHS who knows about their particular needs, their family and their carers. That is the big challenge for the NHS in the next few years.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The Health Secretary does not seem to realise that continuity of care is actually getting worse under him. The GP patient survey shows that the proportion of people who cannot regularly see their preferred GP has risen from 34% in 2012 to 39% in 2014, an increase equivalent to 1.2 million people. Experts say that that is one of the reasons why A and E is under so much pressure. Will he confirm that on Friday it will be precisely one year since hospital A and E departments last met his Government’s own A and E target?

[Mr Hunt]

What I will confirm is that the worst possible thing for continuity of care was Labour’s scrapping of named GPs in 2004. The single thing that makes the biggest difference is to have, for every frail and elderly person in our NHS, someone who is responsible. That is what we are bringing back.

--- Later in debate ---

[Sir Edward Leigh (Gainsborough) (Con)]

5. What steps he plans to take to improve standards in general practice.

[The Secretary of State for Health (Mr Jeremy Hunt)]

We are working hard to improve standards of care in general practice. We have brought back named GPs for those aged 75 and over, introduced a new inspection regime and are doing everything we can to recruit more GPs to improve capacity.

[Sir Edward Leigh]

When will both political parties be honest about the massive looming black hole in health funding, with an ageing population demanding ever better care? We cannot afford to pay for it out of general taxation, so are we going to be honest and have an open debate about moving to the French system of social insurance in which people are charged and repaid if they do not have the means, giving them an infinitely better health service?

[Mr Hunt]

I do not agree with my hon. Friend; let me explain why. The first and important point is that independent studies, such as that which was done last month by the Commonwealth Fund, have ranked the NHS top out of 11 major health economies, including the French example. Money is, of course, tight throughout the NHS, but we have been able to find efficiency savings of £20 billion over the last five years, and we will continue to find them. What I would not support, however, is any system of charging that would make it harder to access NHS services, particularly for older people whom we need to access more services more quickly if the NHS is to be sustainable.

[Lucy Powell (Manchester Central) (Lab/Co-op)]

Let me reassure the Secretary of State that Opposition Members are pleased to see him still in his post today, but if I were him, I would not take that as a compliment. On GP access, what is he actually doing? Survey after survey shows that patient satisfaction with access to their GP is getting worse and worse. That has been borne out in my constituency surgery in a significant number of cases. One constituent recently came to see me who had been discharged from hospital with significant care needs and he was told that he would have to wait three and a half weeks to see his GP. What is the Secretary of State actually doing about it?

[Mr Hunt]

I am delighted that the hon. Lady is delighted that I am in my position here today—we can all be delighted about that wonderful piece of news. Let me tell her that we are doing a lot to improve access to GPs. We have recruited 1,000 more GPs over the course of this Parliament. Let me gently say to her that we can afford those 1,000 GPs only because we pushed on with difficult reforms, getting rid of the PCT bureaucracy and removing 19,000 managers. We would not have been able to afford them if we had listened to her party and continued to spend money on bureaucracy and management.

[Mr Philip Hollobone (Kettering) (Con)]

In every area, there are some very good GPs and some less good ones. How does my right hon. Friend think that clinical commissioning groups should celebrate those GPs who go the extra mile and provide an example for others to follow?

[Mr Hunt]

My hon. Friend has made a very good point. We have learnt from the big efforts to improve standards of care in hospitals—of which I think everyone in the House should be proud—that the best way in which to improve those standards is to be transparent about how well people are doing. What the new chief inspector of hospitals has done is identify not just the failing hospitals that have been put into special measures, but the good and outstanding hospitals, so that they know what they should and can aspire to. I think that we shall hear shortly how the chief inspector of general practice intends to implement the same regime in general practice.

[Mr Speaker]

Order. If the right hon. Gentleman would face the House, it would greatly avail us. I understand the natural temptation to look backwards—[Laughter.]—as in, behind him! But he must face the House.

[Mr Jamie Reed (Copeland) (Lab)]

On 20 June, I wrote to the Secretary of State informing him of the claims of doctors in Cumbria that unless drastic action were taken to reduce the pressures on GPs’ work loads, patients could die. I have not even received a response. Why, having being given such a stark warning, is the Secretary of State sitting on his hands? There are fewer GPs today than there were during Labour’s last year in office. How can standards in general practice be improved when surgeries are dealing with a recruitment crisis?

[Mr Hunt]

Let me give the hon. Gentleman his answer now. According to the Royal College of General Practitioners, 40 million more appointments with GPs are being made in every single year than were made when Labour was in office, and we have 1,000 more GPs than we had when his party was in power.

Let me say very clearly that the way in which we will deal with this problem is by increasing the capacity of general practice and the capacity of primary care. The hon. Gentleman should be supporting that—and he might just think about the 48-hour target that Labour has been talking about. If a new target for GPs is introduced, they will simply cut the amount of time that is available for them to deal with the most frail and vulnerable patients, and that would be wrong.

[Sir Tony Baldry (Banbury) (Con)]

6. What steps his Department is taking to support carers.

--- Later in debate ---

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

11. What progress his Department is making on improving the performance of failing hospitals.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The new special measures regime for failing hospitals is designed to introduce honesty and transparency for hospitals in difficulty. The new chief inspector of hospitals will report later this week on progress in the first year. I am sure that the whole House will welcome the fact that the new regime has made really encouraging progress.

[Gordon Henderson]

Medway NHS Foundation Trust is not in my constituency, but is used by many of my constituents. It was announced last week that Medway is to remain in special measures because of the inadequacies of its A and E department. What steps can my right hon. Friend take to ensure that Medway receives the help needed to improve the service it provides to my constituents?

[Mr Hunt]

I thank my hon. Friend for his question. He is right that the chief inspector raised concerns about some issues that persist at Medway. It is important to praise the staff for the progress that they have made in the past year. We have put in place 113 more nurses, the Bernard dementia unit, which has made some really good progress, and a twinning arrangement with University Hospitals Birmingham, which is one of the best in the country. There are some encouraging signs. I wish to reassure him and his constituents that we will stop at nothing to ensure that we turn that hospital around

[Diana Johnson (Kingston upon Hull North) (Lab)]

The former chief executive of Hull and East Yorkshire Hospitals NHS Trust, Phil Morley, left his post suddenly just before the publication of a very poor Care Quality Commission report, leaving behind a culture of bullying in the trust. Is the Secretary of State as surprised as I am that he has now been appointed chief executive of a hospital in Essex?

[Mr Hunt]

I do not know the details of the individual case, and it would not be right for me to comment. However, what I will say is that we have changed the rules to prevent people who are responsible for poor care from popping up in another part of the system. From now on, when trusts appoint people to boards, they can check their prior records on a central database administered by the CQC. Let me tell the hon. Lady that we are absolutely determined to change the culture in the NHS so that we stamp out the bullying and intimidation that were such a factor for so many doctors and nurses for many years.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

23. Will the Secretary of State join me in congratulating the management and staff of Basildon hospital who have worked hard to turn the hospital around so that it is now rated as good? Will he confirm that his Department will continue to support it so that the hospital can carry on making progress?

[Mr Hunt]

I am delighted with the progress that has been made under Clare Panniker’s leadership. The hospital now has 241 more nurses, and the first maternity unit in the country to be rated as outstanding. My hon. Friend will want to know why it is that when there was a CQC report under the previous Government, it was sat on for six months and nothing was done.

[Mr Nick Gibb (Bognor Regis and Littlehampton) (Con)]

19. In 2005, Littlehampton’s community hospital was demolished to make way for a new community hospital. Weeks later, the plans were put on hold because community hospitals went out of vogue. Sussex Community NHS Trust now wants to increase the number of in-patient beds at community hospitals. Will the Secretary of State ensure that NHS Property Services rebuilds Littlehampton community hospital to deliver those beds where they are needed?

[Mr Hunt]

That is not actually a matter for NHS Property Services Ltd; it has to be locally driven. However, my hon. Friend is absolutely right that we need to enhance community care services, whether in community hospitals or through services delivered at home. My hon. Friend has a high proportion of older people in his constituency and the transformation will be incredibly important for all his constituents.

[Andrew George (St Ives) (LD)]

Will my right hon. Friend join me in welcoming the National Institute for Health and Care Excellence’s statement today on the establishment of safe staffing levels on hospital wards? He will be aware that I have been campaigning on the matter for many years. The 1:8 ratio is certainly not a target but a baseline against which safe staffing and patient care can now be measured.

[Mr Hunt]

I welcome what NICE has done today, because it is incredibly important that we end the scandal of short-staffed wards in our NHS, which was a feature for many years under Governments of both parties. The lesson of Mid Staffs is that the oldest and most vulnerable patients, such as people with dementia, can be forgotten when a hospital is under pressure, so NICE’s guidance will be welcomed and useful. It is important to say that it can save money, because nothing is more expensive than unsafe care.

--- Later in debate ---

[Paul Burstow (Sutton and Cheam) (LD)]

14. What the timetable is for publication of a successor to the current national dementia strategy.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Dementia is one of the most important issues we face at the moment and we are having detailed discussions with stakeholders about the best way to ensure that the very successful Prime Minister’s challenge on dementia continues into the next Parliament.

[Paul Burstow]

I am grateful for that answer and have no doubt that the continuation of the challenge is very important, but both the Prime Minister and the Secretary of State have told the House from the Dispatch Box that there will be a successor to the national dementia strategy. My question was very straightforward. Is there a timetable for delivering that strategy, given that the current strategy ends this year?

[Mr Hunt]

I should clarify for my right hon. Friend that the Prime Minister’s challenge was a successor to the national dementia strategy. The Prime Minister’s challenge finishes at the end of this Parliament and that is why we are having discussions about what should succeed it, because we all have an interest in ensuring that we maintain the tremendous momentum of the past few years.

[Mr Speaker]

I call Michael Connarty—he is not here.

--- Later in debate ---

[James Duddridge (Rochford and Southend East) (Con)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I am pleased to tell the House that on 19 June the Prime Minister hosted a very successful global dementia summit as a follow-up to the G8 dementia summit. We are currently diagnosing and treating 70,000 more people every year with dementia, but the big challenge is, as he set out at the G8 summit, finding a cure or disease-modifying therapy by 2025. We had useful discussions on what barriers need to be eliminated to ensure that the research happens to find such a cure.

[James Duddridge]

What assessment has the Secretary of State made of the need for a single hyper-acute stroke unit in south Essex?

[Mr Hunt]

I know that discussions are going on on that very topic and the CCGs are very interested in putting a hyper-acute stroke service at Southend hospital, which I know has excellent stroke services. We still need further improvements in the ambulance services for the east of England if we are going to do that and that is what we are currently discussing.

[Andy Burnham (Leigh) (Lab)]

I shall begin by congratulating the Health Secretary on surviving the massacre of the moderates. This was no real surprise for those of us on the Opposition Benches, however, because we know that his real views on the NHS are anything but moderate. On his watch, there has been more privatisation and now there is an accelerating postcode lottery. Today, the Royal College of Surgeons has revealed that some people waiting for hip replacements are being denied treatment that is available elsewhere because of arbitrary pain thresholds that are so harsh in places that people must be in severe debilitating pain before they can be treated. This is in direct contravention of National Institute for Health and Care Excellence guidance. Will the Secretary of State today condemn the fact that people are being denied treatment in that way, and act immediately to end the practice?

[Mr Hunt]

Of course it is absolutely right that people should follow NICE guidance, including all clinical commissioning groups, but if the right hon. Gentleman looks at what has happened over the past four years, he will see that we are treating more people, not fewer, with 6,000 more people getting their knees replaced and 9,000 more getting their hips replaced every year. That is possible only because we have 7,000 more doctors in the NHS because we took the difficult decision to get rid of the primary care trusts. Will he now accept that he was wrong to oppose those reforms and wrong to put politics before patients?

[Andy Burnham]

The Secretary of State says that CCGs should be following NICE guidance, but they are not. Seven out of 10 are not following that guidance, and people who are waiting for operations today will be left in pain because he is not acting. The truth is that the reorganisation has resulted in a postcode lottery writ large, and it is worse than we thought, because there is now a proposal in one area to end the provision of hearing aids on the national health service. That is totally unacceptable. Action on Hearing Loss warns that that would set a dangerous national precedent, leaving millions unable to live their lives. So, no ifs, no buts—will he condemn that proposal now and guarantee that patients will not be forced to pay for hearing aids on his watch?

[Mr Hunt]

I make it absolutely clear that everyone should follow NICE guidance. As the right hon. Gentleman has talked about the reorganisation, will he please accept that we are now doing 850,000 more operations on the NHS every single year? That means that more people are getting help with their hearing, their hips and their knees, and with all the other things that they need. He bitterly opposed that reorganisation, but he must now realise that he was wrong to oppose it then and he is wrong to oppose it now.

[Stuart Andrew (Pudsey) (Con)]

T2. I recently had the pleasure of meeting my constituents Susan Childs and Doreen Smulders, who raised the issue of the inequalities that exist for men with prostate cancer. Will my right hon. Friend tell me what steps are being taken to address the shortfalls in care and support that such men are receiving across the country?

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

T3. Since 2010, the percentage of patients who say that they can see their GP within 48 hours has halved from 80% to 40%. Given the pressure on the NHS, and especially on accident and emergency services, will the Secretary of State explain why the Government’s reforms are threatening to close 98 surgeries around the country, including five in Tower Hamlets? Will he publish the full list today?

[Mr Jeremy Hunt]

Let me gently explain to the hon. Lady that she has excellent GP provision in Tower Hamlets, led by Dr Sam Everington. It is a model of what can happen under the Government’s reforms. The way in which we are going to make it easier for people to see their GP is with additional capacity. We have 1,000 more GPs during this Parliament, and we have achieved that only because we took the difficult decision to get rid of 19,000 managers, which was bitterly opposed by the hon. Lady and the Labour party.

[Margot James (Stourbridge) (Con)]

T4. Now that the Medicines and Healthcare Products Regulatory Agency has concluded its consultation on the use of generic asthma inhalers by schools in cases of emergency when a child does not have his or her own inhaler, will my hon. Friend update the House on the next steps? In particular, does she expect schools to be allowed to keep these inhalers in the new school year?

[Barbara Keeley (Worsley and Eccles South) (Lab)]

T6. On nurse-patient staffing ratios, it has been reported in the Health Service Journal that out of 139 trusts surveyed, 119 failed to fill their registered day nurse hours, 112 failed to fill their registered night nurse hours and 105 failed to fill their registered nurse hours across day and night. Is it not time for Ministers and NICE to state straightforwardly that a ratio of one nurse to eight patients or better is the only way for patient safety?

[Mr Jeremy Hunt]

NICE has taken the sensible decision to issue its guidance. It does so independently, but we are not making it mandatory on the advice of the chief nursing officer and many other chief nurses across the country for the simple reason that if we have a mandatory minimum, that can become the maximum that trusts invest in and many wards need more than 1:8. That is why NICE’s guidance was so important today.

[Andrew Selous (South West Bedfordshire) (Con)]

T5. The Chavasse report on improving care for members of the armed services and veterans builds on the improvements that we have already made and has been welcomed by the Department of Health and indeed the Ministry of Defence. We owe it to our armed services to carry on making improvements to their care, so will the Minister encourage NHS England to look favourably on its recommendations?

--- Later in debate ---

[Mr Jim Cunningham (Coventry South) (Lab)]

May I remind the Secretary of State that it takes seven years to train a doctor and most of the doctors he boasts about were trained under a Labour Government? What is he doing about the disparity between GPs surgeries and the service that they offer? Some months ago I made some visits in Coventry and I was amazed by the difference in the levels of service.

[Mr Jeremy Hunt]

It does take seven years to train a GP, but we also have to have an NHS that is able to pay for GPs when they are trained. That is why it was so important to take the difficult decision to reduce the amount of money that we spend on back-office and management costs. The hon. Gentleman is right to say that there is too much disparity in the services offered by different GPs. That is something that the chief inspector of general practice is thinking about, and he will publish his plans shortly.

[Mr Robert Buckland (South Swindon) (Con)]

T8. From my regular discussions with local GPs in Swindon, I know that the reasons behind recruitment issues are often complex and localised. Will my right hon. Friend assure me that those responsible for commissioning GP services will place daily access to general practitioners at the heart of their considerations?

[Mr Hunt]

I know that they do that, and I know that people recognise that access is a critical issue. That is why the Prime Minister introduced a £50 million fund last year that has been taken up by 1,100 of the 8,000 surgeries across the country to improve access in evenings, at weekends and by e-mail and Skype. I hope that those will benefit his constituents.

[Bill Esterson (Sefton Central) (Lab)]

SSP Health runs a number of GP practices in my constituency and across Merseyside. When it took over, it promised full-time GPs and an improvement in services, yet after well over a year several of the practices are still run by locums. We have seen vulnerable, elderly people unable to get appointments for many days, if not weeks, and those who can have gone to other practices. Will the Secretary of State look at what is going on with SSP Health in and around Merseyside and give me and other hon. Members an answer?

[Mr Hunt]

I am happy to do so, because the service that he describes—I have not seen the details—sounds totally unacceptable.

[Paul Burstow (Sutton and Cheam) (LD)]

T9. Given that last year, more than 7,500 people with a mental health crisis found themselves in police cells rather than anywhere appropriate such as a hospital, given that 263 of those people were children and young people, and given that they stayed for 10 and a half hours in a police cell, is it not time that we took the evidence of street triage, which we know works, and rolled it out across the country?

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

I welcome the Secretary of State’s commitment to getting rid of as much bureaucracy as possible, so will he look into what is happening with NHS England in south Yorkshire that is delaying approval for a much-needed GP surgery in my constituency? Given that it is in partnership with the local authority, the delay risks us losing the surgery altogether.

[Mr Jeremy Hunt]

I am happy to look into the details of that case and be as much of a bureaucracy buster as I can.

[Robert Halfon (Harlow) (Con)]

T10. Is my hon. Friend aware that nurses are paying an extra £200 a month and patients an extra £40 a week for ever-increasing hospital car parking charges? Will he look into the problem, meet me and do everything he can to end the great hospital car parking rip-off?

[Mr Hunt]

I share my hon. Friend’s concerns that the car park charges in some hospitals are just too high. I understand that hospitals have financial pressures, as do many parts of the system, but I am happy to talk to him on another occasion about what specifically can be done on this issue.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Annually 30,000 applications for funeral payments are rejected, leaving families committed to expensive funerals that they cannot afford. People who are approaching end of life are not advised, as part of their palliative care, about planning for funeral costs or their eligibility for support. What is the Secretary of State going to do to remedy this?

[Iain Stewart (Milton Keynes South) (Con)]

The Secretary of State will be aware of the campaign run by the Milton Keynes Citizen, my hon. Friend the Member for Milton Keynes North (Mark Lancaster) and myself for an expanded A and E department at Milton Keynes hospital. What assurances can he give me that A and E services at the hospital will be able to meet the needs of an expanding population?

[Mr Jeremy Hunt]

No one could have campaigned harder than my hon. Friend and his hon. Friend the Member for Milton Keynes North (Mark Lancaster) for improving the services at their local A and E department. A consultation is currently taking place. There is no question of closing both A and Es in that area, and I understand that a very good capital bid for £2 million for his local A and E has been put in which, subject to the usual value-for-money requirements, looks like it is very strong.

[Julie Hilling (Bolton West) (Lab)]

My constituent, 81-year-old Rita, was taken seriously ill on holiday and had to spend two weeks in hospital. She was discharged with a letter saying that she needed very urgent surgery, but has had to wait five weeks before she even sees a consultant, let alone getting any treatment. What can the Secretary of State do for Rita and others like her?

[Mr Hunt]

We are working extremely hard to make sure that people do not have those long waits. We are doing about 3.5 million more diagnostic tests, for example, every year in the NHS than four years ago. I am happy to look into the individual case and see what lessons can be learned and to see whether we can help the hon. Lady’s constituent.

[Duncan Hames (Chippenham) (LD)]

Is it ever acceptable, as reported to me in my constituency surgery last week, for a GP to tell their patient, “There is nothing I can do, so I don’t want to hear any more about your mental health”?

Visitor and Migrant NHS Cost Recovery Programme

Jeremy Hunt Excerpts

Monday 14th July 2014 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

The Government have today published the “Visitor and Migrant NHS Cost Recovery Programme—Implementation Plan 2014-16”. This document acts as a statement of purpose and includes commitments for programme delivery as well as announcing policy for increasing cost recovery rates.

The Department of Health is working to create a fairer NHS by improving the systems for charging overseas visitors and migrants to make sure they contribute towards their NHS health care. It is clear that more can be done to increase cost recovery; our independent research estimated that in the financial year 2012-13 we recovered an estimated £73 million, which represented less than 20% of the estimated total possible recovery. To deliver this the Department has been working with the NHS, its arm’s length bodies, and key stakeholders to design and test measures to encourage providers to identify and charge non-EEA visitors and identify and report EEA visitors’ usage of NHS services.

The implementation plan provides a guide to the NHS of how this will be achieved. A key aspect of this is a new financial incentive which will increase the level of cost recovery from chargeable patients from outside the European economic area (non-EEA). This process will enable NHS providers to bill chargeable non-EEA patients at a rate of 150% of standard NHS tariff for the cost of the care provided. The Department intends to lay secondary legislation before Parliament by the end of the 2014-15 financial year to enable this. The Department will keep the rates of the incentives under review to ensure that it is effective and is driving change.

The plan also includes increased scrutiny of the cost recovery from non-EEA patients by NHS providers. This will ensure that their statutory obligation to support NHS sustainability through appropriate identification and charging of visitors and migrants is being met.

These measures will help to underpin and maintain the principles that the NHS will always treat those in urgent need of care and that NHS care is free at the point of delivery for residents. This programme aims to reinforce the fairness of our health service by ensuring that everyone who is not entitled to free health care contributes to the cost of running the NHS.

“Visitor and Migrant NHS Cost Recovery Programme—Implementation Plan 2014-16” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.